Seventh Postoperative Day Research Articles

Efficacy of Laparoscopic Left Hemihepatectomy Combined With Choledochoscopic Lithotomy for Complex Intrahepatic Bile Duct Stones and Its Impact on Postoperative Liver Function.

This study was designed to investigate the clinical efficacy of laparoscopic left hemihepatectomy combined with choledochoscopic lithotomy for patients with complex intrahepatic bile duct stones. The clinical data of 97 patients with complex intrahepatic bile duct stones treated in our hospital between February 2019 and April 2022 were retrospectively collected. Patients were allocated into 2 groups based on their surgical approaches. In the control group, 46 patients underwent laparoscopic left hemihepatectomy, while in the combined group, 51 patients underwent laparoscopic left hemihepatectomy combined with choledochoscopic lithotomy. Parameters such as clinical efficacy, surgical indices, stress response markers (CRP, EP, COR), coagulation metrics (FIB, APTT, PT), liver function indicators (GGT, TBIL, ALT), complications, and quality of life were compared between the 2 groups. The combined group exhibited a significantly higher total effective rate compared with the control group (98.04% vs. 82.61%) (P<0.05). The operation duration of the combined group was longer than that of the control group. However, the duration for postoperative anal exhaustion, postoperative bed mobility, postoperative drainage, and hospital stay was shorter in the combined group than in the control group (P<0.05). CRP, EP, and COR concentrations were substantially elevated in both groups on the third postoperative day (P<0.05), but were lower in the combined group. Similarly, levels of FIB, APTT, and PT were markedly increased in both groups on the third postoperative day (P<0.05), but were lower in the combined group. On the seventh postoperative day, GGT, TBIL, and ALT were notably decreased in both groups, with the combined group exhibiting lower levels (P<0.05). The incidence of complications in the combined group was lower than that of the control group (5.88% vs. 19.57%) (P<0.05). At 3 months postoperatively, all GIQLI scores were markedly elevated in both groups, with superior scores observed in the combined group (P<0.05). The combined laparoscopy and choledochoscopy demonstrate a remarkable efficacy for complex intrahepatic bile duct stones, which significantly facilitate liver function recuperation, reduce stress reactions, reduce complications, enhance the quality of life, and exert a minimal impact on coagulation functions.

Gastrointestinal stromal tumor in Carney’s triad with laparoscopic total gastrectomy: a case report

IntroductionCarney's triad is a rare syndrome characterized by the co-occurrence of gastric gastrointestinal stromal tumor (GIST), pulmonary chondroma, and extra-adrenal paraganglioma. We present a case of a young woman with GISTs associated with this triad.Case presentationA 28-year-old woman was identified with multiple gastric tumors and a right lung nodule during a routine health check-up. CT scans and upper gastrointestinal endoscopy revealed a 50 mm mass on the lesser curvature of the stomach, along with two additional gastric lesions and a 20 mm nodule in the right lung. The patient had a history of right middle lobectomy at the age of 19 for pulmonary chondroma. During surgery, enlarged lymph nodes were observed, indicating metastasis, which necessitated a total gastrectomy with radical (D2) lymph node dissection. Pathological examination confirmed seven GISTs, with immunohistochemical staining positive for KIT (+), DOG1 (+), and negative for SDHB (−). The postoperative course was uneventful, and the patient was discharged on the seventh postoperative day. Despite opting out of adjuvant imatinib therapy, she remains disease-free 2 years postoperatively.ConclusionsThis case underscores the necessity of total gastrectomy with lymph node dissection due to the high incidence of metastasis in GISTs associated with Carney's triad. Further research is required to determine the optimal extent of lymph node dissection in such cases.

Mechanical Viability and Functionality Assessment of a New Sutureless Endoluminal Microvascular Device: A Preliminary In Vivo Rabbit Study.

Our group has developed a new nitinol endoluminal self-expandable device for microvascular anastomosis. It attaches to each vessel ending with opposite directed microspikes and reaches complete expansion at body temperature, using the nitinol shape memory capacity. The main purpose of this first in vivo trial is to evaluate the mechanical viability of the device and its immediate and early functionality. A recuperation study with seven New Zealand White rabbits was designed. A 1.96 mm outer diameter prototype of the new device was placed on the right femoral artery of each rabbit. Each anastomosis was reassessed on the seventh postoperative day to reevaluate the device function. The average anastomosis time with the new device was 18 min and 45 seg (±0.3 seg). It could be easily placed in all the cases with an average of 1.14 (1) complementary stitches needed to achieve a sealed anastomosis. Patency test was positive for all the cases on the immediate assessment. On the 1 week revision surgery, patency test was negative for the seven rabbits due to blood clot formation inside the device. The new device that we have developed is simple to use and shows correct immediate functionality. On the early assessment, the presence of a foreign body in the endoluminal space caused blood clot formation. We speculate that a heparin eluting version of the device could avoid thrombosis formation. We consider that the results obtained can be valuable for other endoluminal sutureless devices.

Correlation between Delayed Relief after Microvascular Decompression and Morphology of the Lateral Spread Response in Patients with Hemifacial Spasm-Further Examination with Compound Motor Action Potentials.

Although microvascular decompression (MVD) is a reliable treatment for hemifacial spasm (HFS), postoperative delayed relief is one of its main issues. We previously evaluated the morphology of the lateral spread response (LSR) and reported correlation between delayed relief after MVD and polyphasic morphology of the LSR. This study aimed to investigate the morphology of LSR and the course of recovery of the compound motor action potential (CMAP), to better understand the pathophysiology of delayed healing of HFS. Based on the pattern of the initial LSR morphology on temporal and marginal mandibular branches stimulation, patients were divided into two groups: the monophasic and polyphasic groups. The results of MVD surgery and sequential changes in the CMAP were evaluated 1 week, 1 month, 1 year, and final follow-up after the surgery. Significantly higher rates of persistent postoperative HFS were observed in patients with the polyphasic type of initial LSR at 1 week and 1 month after the surgery (P < 0.05, respectively). In the polyphasic group, the amplitude of the CMAP tended to gradually improve with time, while in the monophasic group, the amplitude of the CMAP decreased on the seventh postoperative day, followed by its gradual improvement. There is a significant correlation between delayed relief after MVD and polyphasic morphology of the initial LSR in patients with HFS. In the polyphasic group, CMAP recovered earlier and showed less reduction in amplitude, suggesting segmental demyelination, with less damage to peripheral nerves.

Higher erythrocytes in cerebrospinal fluid on the first and seventh postoperative day: Associated with poor outcome in aneurysmal subarachnoid hemorrhage patients.

Aneurysmal subarachnoid hemorrhage is an acute cerebrovascular disease with high disability and mortality. We intended to explore the association between levels of erythrocytes in cerebrospinal fluid at different times of hemorrhage and the outcome of patients. One retrospective study including 216 patients with aneurysmal subarachnoid hemorrhage undergoing surgeries in the First Affiliated Hospital of Yangtze University from January 2020 to July 2023 was carried. The univariable analysis and multivariable logistic regression analysis were used for factors associated with poor outcome. The level of erythrocytes in cerebrospinal fluid on the 1st postoperative day in patients with poor outcome was 311 × 103/µL, significantly higher than patients with good outcome (108 × 103/µL), P < .001. The level of erythrocytes in cerebrospinal fluid on 7th postoperative day was 86.5 × 103/µL, also significantly higher than patients with good outcome (26.0 × 103/µL). The multivariable logistic regression analysis results showed that erythrocytes in cerebrospinal fluid on the 1st postoperative day (≥177 × 103/µL) and on the 7th postoperative day (≥53.5 × 103/µL) were possibly associated with poor outcome in aneurysmal subarachnoid hemorrhage patients. Treatment with tranexamic acid and continuous lumbar drainage did not result in a decrease of erythrocytes in cerebrospinal fluid. Higher erythrocytes in cerebrospinal fluid on the 1st and 7th postoperative days were associated with poor outcome in aneurysmal subarachnoid hemorrhage patients.

Three-dimensional Morphometric Analysis of the Effectiveness of Kinesio Taping on Postoperative Discomfort Following Mandibular Third Molar Surgery: A Prospective Randomized Split-mouth Study

This study investigates the efficacy of Kinesio taping (KT) in reducing postoperative discomfort, including edema, trismus, and pain, following mandibular third molar extraction. A prospective randomized split-mouth design was employed, involving 7 patients with impacted mandibular third molars. KT was applied immediately postsurgery, and outcomes were assessed on the third and seventh postoperative days using a Visual Analog Scale (VAS) for pain, 3D morphometric analysis for swelling, and caliper measurements for trismus. Results showed significant reductions in pain, swelling, and trismus on the KT-treated side compared with the control side. The most notable differences were observed on day 7, where KT demonstrated superior effectiveness in alleviating symptoms. The control group showed improvement over time, but the KT-treated group experienced faster and more pronounced recovery. In conclusion, KT proved to be a safe and effective method for improving postoperative recovery following mandibular third molar surgery, offering a low-cost, accessible option to enhance patient comfort and quality of life.

The Impact of Muscle Energy Techniques on the Temporomandibular Motions Following Extraction Surgery of the Third Molar Tooth: A Randomised Clinical Trial.

Trismus and subsequent restricted range of motion in the temporomandibular joint may impede vital activities of daily living. The primary purpose of the current study was to explore the impact of muscle energy techniques on the range of temporomandibular motions in individuals with trismus and restricted range of the temporomandibular motions after third molar extraction surgery. Eligible volunteers were randomly assigned to either the intervention or control group. Participants in the intervention group received muscle energy techniques over seven consecutive postoperative days, while those in the control group did not receive any intervention. Both groups adhered to the recommended postoperative healthcare protocol provided by a single dentist. The range of cardinal and linear intra-articular motions of the temporomandibular joint was assessed on the first, second and seventh postoperative days in each group using a vernier calliper and an ultrasound machine, respectively. The range of linear intra-articular motion (p-value < 0.001) and cardinal motion (p-value < 0.032) of the TMJ significantly increased within groups after the first postoperative week. The range of temporomandibular motions, except for the forward displacement of the mandibular condyle (p-value = 0.193), and the range of mandibular retrusion (p-value = 0.339) exhibited a significant difference between groups (p-value < 0.017) after the first postoperative week. The current study revealed, for the first time, that muscle energy techniques increase the range of cardinal and linear intra-articular motions in individuals with trismus and restricted range of the temporomandibular motions following third molar extraction surgery. Clinical Trials: IRCT20211016052783N1.

Wolf in sheep’s clothing: a case of primary lung adenosquamous carcinoma mimicking traumatic pulmonary pseudocyst

BackgroundTraumatic pulmonary pseudocyst is a rare “cystlike” lung lesion that typically develops following blunt chest trauma. It differs from lung cancer associated with cystic airspaces in terms of pathogenic mechanisms, clinical manifestations, and radiological features. Furthermore, there are few reports of the diagnostic bias between traumatic pulmonary pseudocyst and lung cancer associated with cystic airspaces. Here, we present a rare case of lung cancer associated with cystic airspaces that mimicks traumatic pulmonary pseudocyst.Case presentationA 61-year-old man with no chest medical or surgical history, no chest radiologic examination within the last five years, and no smoking history had an air-filled “cystlike” lesion surrounded by solid components and ground-glass opacities in the middle third of the right upper lobe of the lung during a computed tomography evaluation following blunt chest trauma. He was initially diagnosed with traumatic pulmonary pseudocyst and treated conservatively. On the third post-trauma day, he experienced hemoptysis, which was successfully treated with intravenous hemostatic medication. On the ninth post-trauma day, he exhibited a significant hemoptysis and a moderate dyspnea. A subsequent chest computed tomography scan demonstrated that the solid components had entered the lesion’s cavity and significantly expanded, and the surrounding ground-glass opacities had slightly enlarged. A contrast-enhanced chest computed tomography scan and a three-dimensional reconstruction computed tomography image confirmed that the solid components were a hematoma caused by damage to the right upper pulmonary vein. A right upper lobectomy was performed based on the concern about severe intrapulmonary bleeding. An intraoperative frozen section analysis showed significant bleeding in the lung parenchyma. Adenosquamous carcinoma was unexpectedly identified during the postoperative pathological examination of the resected specimen. A diagnosis of primary lung adenosquamous carcinoma was made. He was discharged on the seventh postoperative day and followed up for two years without any recurrence.ConclusionsThe potential of lung cancer associated with cystic airspaces should be considered for “cystlike” lung lesions discovered in elderly patients after blunt chest trauma. A comprehensive review of the medical history, meticulous analysis of the radiological findings, and close monitoring can help clinicians reduce the risk of diagnostic bias.

Correlation between Functionality and Quality of Life in Patients after Cardiac Surgery

&lt;b&gt;Abstract&lt;/b&gt;&lt;br /&gt; This study aims to investigate the relationship between early physical exercise and patients' functional ability and quality of life after cardiac surgery. A total of 100 patients, ages 18 to 65, 52 men and 48 women, took part in the early physical activity program following cardiac surgery from the first to the seventh postoperative day. The six-minute walk test (6MWT), short form-international physical activity questionnaire (SF-IPAQ), and short form-36 (SF-36) quality of life were used as outcome measures. Each test and questionnaire completed on the seventh day following cardiac surgery. According to statistical analysis, there was a statistically significant correlation (P&amp;lt;0.001) between the SF-IPAQ score and the 6MWT and SF-36. According to our findings, patients who had heart surgery reported higher levels of physical activity and better quality of life as well as increased functional ability.

The Impact of the Chlorhexidine Gel (WISDOM®) on Postoperative Sequelae Associated with the Surgical Removal of Impacted Mandibular Third Molars: A Randomized Controlled Clinical Trial

Background: One of the most prevalent procedures in oral surgery is the removal of impacted mandibular third molars, typically accompanied by trismus, edema, and pain. Several methods and biomaterials were implemented to mitigate or avoid these surgical problems. Objectives: To evaluate the efficiency of chlorhexidine gel (WISDOM®) in minimizing postoperative sequelae associated with the impacted mandibular third molar that will be surgically extracted and its role in promoting early soft tissue closure of the surgical site. Methods: The study design was a double-masked and randomized, controlled clinical study that included healthy patients needing the removal of a mandibular third molar through surgery. The participants were randomly assigned to two groups. The extraction site of the study group was filled with a mixture of gel foam and WISDOM®. In contrast, we filled the extraction sites of the control group patients with gel foam and sutured the surgical sites for both groups. The patients were evaluated on the first, third, and seventh postoperative days for pain, swelling, trismus, and early soft tissue healing. Results: Sixty eligible patients were enrolled in this study. The study group exhibited a statistically significant decrease in pain, edema, trismus, and early soft tissue healing on the first, third, and seventh postoperative days compared to the control group. Conclusions: WISDOM® gel can effectively reduce postoperative pain, trismus, and swelling and promote early soft tissue healing after surgical removal of an impacted mandibular wisdom tooth.

Effect of Adding Integrated Core and Graduated Upper Limb Exercises to Inpatient Cardiac Rehabilitation on Sternal Instability After Coronary Artery Bypass Grafting: A Randomized Controlled Trial

ObjectiveTo evaluate the effect of adding integrated core and graduated resistance upper limb exercises to an inpatient cardiac rehabilitation program in patients with acute sternal instability after coronary artery bypass grafting (CABG). DesignThis was a single-center, randomized, controlled, parallel-group intervention study. SettingThis study was conducted at the National Heart Institute. ParticipantsForty patients with post-CABG with sternal instability aged 50-60 years completed this study and were randomized into 2 groups: an intervention group (n=20) and an active control group (n=20). InterventionThe intervention group (A) received a routine inpatient rehabilitation program from the first postoperative day plus integrated core and graduated resistance upper limb exercises, which started from the seventh postoperative day for approximately 4 weeks, whereas the control group (B) received only the routine inpatient rehabilitation program. Main Outcome MeasuresSternal separation measured by ultrasonography, visual analog scale for measuring pain, and activities of daily living (ADL) index were main outcome measures. ResultsPatients in the intervention group (A) showed a significant reduction in sternal separation from the supine and long sitting positions, whereas those in the control group (B) showed a significant increase in sternal separation (P=.0001). Both groups showed a reduction in pain, and an increase in the ADL score was observed in group A. There was a significant interaction between the time and group effects (P=.0001). ConclusionAdding integrated core and graduated upper limb exercises to inpatient cardiac rehabilitation for patients with sternal instability after coronary artery bypass grafting significantly improved sternal healing, pain, and ADL.

Endobronchial Closure for Peripheral Pulmonary Air Leakage

Introduction: A minimally invasive alternative to surgery for treating pneumothorax has been developed, aiming to reduce risks while maintaining efficacy. This study conducted basic experiments using ex vivo and in vivo pig lung employing a super-thin catheter for treatment. This new device injects fibrin glue directly into the responsible lesion to close the air leak, which has two features: thin design and double-lumen. Methods: The experimental setup involved utilizing trachea and both lung specimens from pigs under positive pressure ventilation. To simulate pneumothorax, artificial fistulas were created on the lung surfaces. The super-thin catheter, guided through a bronchoscope near the fistula, was used to embolize the peripheral bronchus by injecting a fibrin preparation. Then, an air leak test was conducted afterward to assess the efficacy of the treatment. Additionally, a similar pneumothorax model was induced in alive pig under general anesthesia to evaluate its curability. Results: In the extracted pig lungs, embolization was performed in 21 cases, resulting in the cessation of air leaks in 19 cases, corresponding to a 90.5% cure rate. Notably, no major adverse events occurred with the treatment devices. Similarly, in living pigs, pneumothorax was successfully treated, with no recurrence observed up to the seventh postoperative day. Conclusion: The novel treatment device utilizing a super-thin catheter offers a minimally invasive and highly curative option for pneumothorax. These promising results suggest the potential for further development and human clinical trials, which could revolutionize the treatment of pneumothorax, reducing risks and improving outcomes.

Frequency of surgical site infection after single dose of preoperative antibiotics in children with uncomplicated acute appendicitis: a cross-sectional study

Background: Hyperaemic suppurative appendicitis, or uncomplicated appendicitis, often requires an appendectomy. Surgical Site Infection (SSI) is common post-surgery, and prophylactic studies show ceftriaxone and metronidazole effectively protect against most causative organisms. Methods: Ninety patients were included through non-probability convenience sampling. Acute appendicitis was diagnosed using the Alvarado score, with surgery for scores of 7 or higher. A single preoperative dose of ceftriaxone and metronidazole was administered. Follow-up visits included stitch removal on the seventh postoperative day and monitoring up to the tenth postoperative day using the Southampton criteria for wound infection. Results: Of the 90 patients, 64 (71.1%) were male and 26 (28.9%) were female. Fifty (55.6%) scored 7-8 on the Alvarado score, and 40 (44.4%) scored 9-10. Using the Southampton criteria, 5 (5.6%) developed grade I SSI. Infection rates showed no significant difference between male (3.1%) and female (11.5%) patients (p value &gt;0.05) or by Alvarado score and symptom duration. No cases of SSI beyond grade II were observed. Conclusions: Administering a single preoperative antibiotic dose effectively minimizes surgical site infection in children with uncomplicated acute appendicitis, demonstrating clear management advantages.

Rapid alleviation of perioperative airway obstruction through positional adjustments in a patient with a giant anterior mediastinal mass: A case report

Rationale: This case describes the rapid resolution of acute airway obstruction after anesthesia induction in a young man with a massive 12.7 × 9 × 12 cm anterior mediastinal tumor. It emphasizes the remarkable effectiveness of positional adjustments in immediately alleviating airway compression caused by large mediastinal masses. The crisis was resolved quickly and without invasive measures through only positional tactics, without the need for emergency invasive interventions. This highlights the decisive role of strategic patient positioning as a primary technique for perioperative management of mediastinal masses, ensuring adequate ventilation and preventing catastrophic outcomes. Patient concerns: Due to the unique anatomical location of mediastinal tumors, the anesthesia risks for patients with mediastinal tumors are very high. These tumors can cause airway compression, leading to severe cardiovascular dysfunction and even mortality during general anesthesia. Diagnoses: Combining the patient’s medical history, symptoms and signs, fiberoptic bronchoscopy and excluding other causes, it was confirmed that the tumor compressed the airway and blocked the airway. Interventions: Ventilation was rapidly improved by adjusting the patient’s position, ultimately to the left lateral decubitus position with head-up tilt. Outcomes: Through positional adjustment, the patient’s airway obstruction symptoms rapidly improved. Airway pressure decreased significantly, end-tidal carbon dioxide returned to 40 mm Hg, and oxygen saturation increased to 95%. The mediastinal tumor was ultimately successfully resected. The surgical procedure went smoothly with successful extubation on the first postoperative day. The patient had a smooth recovery and was discharged on the seventh postoperative day without any lingering postoperative complications. Lessons: This case provides an important educational illustration of how mediastinal mass patients can develop sudden catastrophic airway obstruction after induction despite being asymptomatic preoperatively. It demonstrates an effective crisis rescue technique through positioning that may help inform management of similar high-risk cases.

Management of Mild Postpartum Anemia: Is Iron Administration Effective?

Background This study aimed to investigate the efficacy of iron therapy in the treatment of mild postpartum anemia. Methods We conducted a case-control study involving women who underwent cesarean section at our hospital between 2015 and 2020. Following propensity score matching, participants were categorized into two groups based on whether or not they received iron therapy. These patients were evaluated for mean hemoglobin (Hb) levels on the seventh postoperative day (POD 7), the percentage of subjects achieving Hb greater than 10 g/dL on POD 7, and the incidence of adverse events. The efficacy of iron administration was evaluated using a superiority test, and receiver operating characteristic analyses were employed to generate area under the receiver operating characteristic curves (AUROC). Results The mean Hb level on POD 7 was 10.12 g/dL in the iron group and 9.89 g/dL in the iron-free group (P = 0.206). The superiority test revealed that the percentage of subjects achieving Hb levels greater than 10 g/dL on POD 7 was 56.1% in the iron group and 48.8% in the iron-free group (P = 0.880), indicating that the iron group did not demonstrate superiority over the iron-free group. The incidence of adverse events was significantly higher in the iron group (P = 0.027). The highest AUROC was observed with preoperative mean corpuscular Hb, measuring 0.632 (95% CI: 0.509-0.755), with a cutoff point of 28.5 pg. Conclusion Consideration should be given to the uniform administration of iron for the management of mild postpartum anemia.

Transperineal Laser Ablation for Focal Therapy of Localized Prostate Cancer: 12-Month Follow-up Outcomes from a Single Prospective Cohort Study.

To evaluate the oncological and functional outcomes of transperineal laser ablation (TPLA) as the focal therapy for localized prostate cancer (PCa) after a 12-month follow-up. Patients with low- and intermediate-risk localized PCa were prospectively treated with focal TPLA between July 2021 and December 2022. The inclusion criteria were the following: clinical stage < T2b; PSA < 20 ng/mL; International Society of Urological Pathology (ISUP) grade ≤ 2; MRI-fusion biopsy-confirmed lesion classified as PI-RADS v2.1 ≥ 3. Intra-, peri-, and post-operative data were collected. Variables including age, PSA, prostate volume (PVol), Charlson's Comorbidity Index (CCI), International Prostate Symptom Score (IPSS) with QoL score, International Index of Erectile Function (IIEF-5), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and Male Sexual Health Questionnaire-Ejaculatory Dysfunction Short Form (MSHQ-EjD) were collected at baseline and at 3, 6 and 12 months after TPLA. Post-operative mpMRI was performed at 3 and 12 months. Finally, all patients underwent prostatic re-biopsy under fusion guidance at 12 months. The success of this technique was defined as no recurrence in the target treated lesion at the 12-month follow up. Twenty-four patients underwent focal TPLA. Baseline features were age [median 67 years (IQR 12)], PSA [5.7 ng/mL (3.9)], PVol [49 mL (27)], CCI [0 (0)], IPSS [11 (9)], IPSS-QoL [2 (2)], IIEF-5 [21 (6)], ICIQ-SF [0 (7)], MSHQ-EjD ejaculation domain [14 (4)] and bother score [0 (2)]. Median operative time was 34 min (IQR 12). Median visual analogue scale (VAS) 6 h after TPLA was 0 (IQR 1). The post-operative course was regular for all patients, who were discharged on the second post-operative day and underwent catheter removal on the seventh post-operative day. No patient had incontinence at catheter removal. A significant reduction in PSA (p = 0.01) and an improvement in IPSS (p = 0.009), IPSS-QoL (p = 0.02) and ICIQ-SF scores (p = 0.04) compared to baseline were observed at the 3-month follow-up. Erectile and ejaculatory functions did not show any significant variation during the follow-up. No intra- and peri-operative complications were recorded. Three Clavien-Dindo post-operative complications were recorded (12%): grade 1 (two cases of urinary retention) and grade 2 (one case of urinary tract infection). At the 12-month follow-up, eight patients showed mpMRI images referable to suspicious recurrent disease (PIRADS v2.1 ≥ 3). After re-biopsy, 7/24 patients' (29%) results were histologically confirmed as PCa, 3 of which were recurrences in the treated lesion (12.5%). The success rate was 87.5%. The focal TPLA oncological and functional results seemed to be encouraging. TPLA is a safe, painless, and effective technique with a good preservation of continence and sexual outcomes. Recurrence rate at 12 months was about 12.5%.

Efficacy of Submucosal versus Pterygomandibular Dexamethasone Injection in Surgical Extraction of the Impacted Lower Third Molar

Objectives: This study aimed to evaluate the efficacy and postoperative complications of preoperative submucosal dexamethasone injection compared to preoperative dexamethasone injection into the pterygomandibular space for surgical extraction of the impacted lower third molar. Study design and setting: This was a quasi-experimental, cross-sectional study conducted at the Department of Oral and Maxillofacial Surgery, Dow International Dental College, Dow University of Health Sciences, Karachi, from April to July 2021. Methodology: The study sample consisted of 72 patients who reported surgical extraction of their lower wisdom teeth and consented to participate in this study. The patients were randomly divided into the submucosal injection group (SM) and the pterygomandibular space (PM) group. The injection time was recorded on the second and seventh postoperative days. Results: No significant differences in the duration of the intervention were observed between the two groups (23.08 min in PM, 23.07 min in SM). The postoperative facial swelling was significantly reduced transversely (ear lobe to the angle of the mouth) in both groups compared to their respective baselines on the first postoperative day. On the secondpostoperative day, significant changes were observed in the submucosal group in postoperative swelling. Conclusions: Using intraoral dexamethasone injections in third molar surgery significantly reduces conventional complications of surgery while avoiding the systemic side effects of steroids. Dexamethasone should be used regardless of the administration site when warranted, with less apprehension than is common in dentistry

A case of truncus arteriosus with severe heart failure and pulmonary stenosis: bridge to transplant candidacy with surgical correction and a ventricular-assist device.

Ventricular-assist device therapy for small patients with congenital heart disease is challenging due to its complex anatomy and hemodynamics. We describe a 3-year-old patient with heart failure with truncus arteriosus in the palliative stage. The patient underwent palliative right ventricular outflow tract reconstruction following bilateral pulmonary artery banding. At 6months of age, the patient developed severe truncal valve regurgitation and left ventricular dysfunction. Emergent truncal valve replacement with a mechanical valve was performed, but left ventricular dysfunction persisted. At 3years of age, the patient developed acute progression of heart failure triggered by influenza infection. The patient was intubated and transferred to our center to determine the indication for heart transplantation. On the second day after admission, signs of multiorgan failure appeared. Emergent ventricular-assist device implantation for both ventricles was performed with truncal valve closure, ventricular septal defect closure, atrial septal defect closure, and re-right ventricular outflow tract reconstruction. The right ventricular-assist device was successfully removed on the seventh postoperative day. Due to the small pulmonary arteries, severe pulmonary stenosis persisted after ventricular-assist device implantation, but it gradually improved with multiple pulmonary angioplasties. The patient was registered in the Japanese organ transplant network and is awaiting a donor organ in a stable condition.

Methylene Blue as an Adjuvant Analgesic Postoperative Anal Fistula: A Randomized Clinical Trial

Introduction. Anal fistula is a pathological condition that connects the anorectal mucosa to the perianal skin, requiring various types of surgical procedures. However, surgery often causes postoperative pain. The use of methylene blue is being studied as a potential analgetic adjuvant in anal fistula surgery. Previous studies have shown that methylene blue can effectively reduce postoperative pain in various types of anorectal surgery. This study aims to determine methylene blue's clinical efficacy as an analgetic adjuvant. Methods. A double-blind, randomized controlled trial was conducted. Subjects consisting of subjects with simple anal fistula to undergo fistulectomy were randomly allocated into two groups. The first group received adjuvant analgesics in the form of methylene blue and NSAIDs, while the second group only received NSAIDs. Methylene blue 4 mL 1% was administered subcutaneously to the edge of the wound, sprayed on the surgery site, and intravenously administered ketorolac 3 x 30 mg. Randomization was done using the double-blind method. Pain levels were evaluated on the first, second, third, and seventh postoperative days using a visual analog scale (VAS). Results. Thirty-four subjects were enrolled (17 subjects in each group). Significant differences in pain levels (VAS values) were recorded between the group receiving the combination of methylene blue and NSAIDs compared to the group receiving only NSAIDs on days 1 to 3 after surgery (p &lt;0.05). This difference was no longer significant between the two groups on the seventh postoperative day (p &gt;0.05). Conclusion. The use of methylene blue in subjects undergoing anal fistula surgery as an adjuvant analgesic along with NSAIDs may reduce the intensity of pain better than NSAIDs alone.

Is Piezosurgery Associated with Improved Patient Outcomes Compared to Conventional Osteotomy in Rhinoplasty? A Systematic Review and Meta-Analysis of RCTs.

Background: Rhinoplasty is a common plastic surgery procedure with evolving surgical techniques. This systematic review and meta-analysis compares the outcomes of piezosurgery versus conventional osteotomy in rhinoplasty. Methods: A comprehensive search of six databases yielded 12 randomized controlled trials (RCTs) comparing piezosurgery (292 cases) to conventional osteotomy (338 cases) in rhinoplasty patients. The examined outcomes included postoperative edema, ecchymosis, complications, pain (using the Visual Analogue Scale-VAS), and operative time. Subgroup analyses were conducted based on the assessment timepoint, surgical approach, and outcome grade. The risk of bias was evaluated using the revised Cochrane tool. Results: Piezosurgery showed a significant reduction in the degree of postoperative edema (second and seventh postoperative days) and ecchymosis (second, fourth, and seventh postoperative days). The external approach in piezosurgery demonstrated greater benefits for both outcomes. Piezosurgery was associated with a significant reduction in overall complications, especially mucosal injuries, compared to conventional osteotomy, with no significant difference regarding postoperative hemorrhage. A significant reduction in pain scores and the need for analgesia was observed with piezosurgery. No significant difference was found in operative time. Conclusions: Piezosurgery offers significant benefits in patient outcomes, with similar operative time between both techniques. However, long-term investigations are still needed.