Tamponade Research Articles

Design and Development of a Cost-Effective Transnasal Skull Base Bone Wax Applicator: A Technical Note.

Bone wax is an important hemostatic agent used in neurosurgical practice from more than a century. It acts by mechanical tamponade effect to stop the oozing from cancellous bone. Bone wax application over the skull surface over the vertex is easy and can be applied with fingers. In deeper areas, one uses dissector to apply the bone wax; however, it becomes difficult at times to apply in transnasal surgery using the same dissectors. Author designed a cost-effective 20-cm-long different angled bone wax applicator for skull base transnasal surgery. This applicator is cost-effective and not described previously in English literature.

Оценка метода профилактики девиации ирригационного потока при факоэмульсификации с использованием дисперсивного вискоэластика (Вискоблок) в аспекте состояния витреолентикулярного интерфейса

Purpose. Evaluate state of the vitreolenticular interface before surgery, during phacoemulsification of cataract, and in the early postoperative period. To assess the effectiveness of «Viscoblock» method application during phacoemulsification to prevent intraoperative irrigation fluid misdirection syndrome by blocking the penetration of irrigation fluid through the zonular fibers through injecting dispersive ophthalmic viscosurgical device behind the iris. Material and methods. We operated 49 patients (50 eyes) diagnosed with age-related cataracts. All patients were divided into two groups. In the first group, we performed phacoemulsification with hydrophobic intraocular lens (IOL) implantation and application of the «Viscoblock» method. This group included 24 patients. In the second group, we performed phacoemulsification with hydrophobic IOL implantation using standard technique, it included 25 patients. All patients underwent standard ophthalmological examination and specific additional ones: ultrasound biomicroscopy – UBM Aviso (Quantel Medical, France); spectral optical coherence tomography OCT (Solix, Optovue, USA). Surgical treatment was performed under the control of an operating microscope equipped with intraoperative OCT (Lumera Rescan 700, Carl Zeiss, Germany). Results. According to preoperative diagnostics and it's UBM data, all patients in the first and second groups showed abnormalities in lens zonular fibers. According to OCT data before the surgery, no cases of anterior hyaloid membrane (AHM) detachment were detected. During the surgery, AHM detachment was observed in 24% of cases in first group and in 56% of cases in second group. Intraoperative iris prolapses occurred in 8% of cases only in the first group. Posterior capsule rupture was observed in only 1 patient in second group. Conclusion. Our technique, «Viscoblock», allows us to limit the penetration of irrigation fluid through the Zonula ciliaris in 76% of cases. However, it should be noted that the method does not provide complete prevention of AHM detachment, as it may already exist in some patients. Additionally, we cannot exclude partial washout of viscoelastic substance during the surgery, which can reduce the tamponade effect. Key words: vitreo-lenticular interface, Berger's space, intraoperative fluid misdirection syndrome, optical coherence tomography, ultrasound biomicroscopy, «Viscoblock», cataract, lens zonular fibers, vitreous body, posterior lens capsule, anterior hyaloid membrane, intraocular lens

Effectiveness of Silicone Oil Tamponade with Pars Plana Vitrectomy in Isolated Cases of Vitreous Hemorrhage with Advanced Diabetic Retinopathy

Purpose: To assess the effectiveness and safety of silicone oil as tamponade in vitrectomy performed for isolated cases of vitreous hemorrhage in patients with advanced diabetic retinopathy. Study Design: Quasi experimental. Place and Duration of Study: Al-Ibrahim Eye Hospital, Karachi from October 2022 to March 2023. Methods: Forty two cases of advanced diabetic retinopathy (either sex), with developing vitreous hemorrhage (active bleeding) were enrolled through convenient sampling. Demographic characteristics and pre-operative examination of eyes including Best corrected visual acuity (BCVA), intraocular pressure (IOP), indirect ophthalmoscopy, gonioscopy and ultrasonography (in cases where fundus was not visible) were performed. All the patients underwent pars plana vitrectomy (PPV) and pan retinal photocoagulation (PRP). Silicone oil was used as tamponade. Post-operative follow up was at first week after surgery and repeated at 3rd month and 6th month. Effect of silicon oil tamponade on re-bleeding after surgery was specifically observed. Anatomical outcome and side effects were also noted during the study period. Results: Out of 42 cases, re-bleed occurred in 2 cases (4.76 %). However, intraocular pressure (IOP) was raised in 3cases (7.1%) and cataract formed in 2 cases (4.76%). No other side effect was observed throughout the study period. Conclusion: Use of silicone oil as tamponade effectively decreases re-bleeding in patients of advanced diabetic retinopathy after vitrectomy. However, few complications such as increased intraocular pressure and cataract can occur that are manageable both medically and surgically.

Microvascular changes after pars plana vitrectomy for rhegmatogenous retinal detachment repair: A comparative study based on gas tamponade agent.

The purpose of this study was to investigate the effect of gas tamponade on microvascular changes in patients with rhegmatogenous retinal detachment (RRD), who underwent pars plana vitrectomy (PPV), using optical coherence tomography angiography (OCTA). Participants in this study were 48 patients with RRD, who were treated with PPV and gas tamponade without internal limiting membrane peeling. All participants underwent slit-lamp examination, fundoscopy, spectral domain-optical coherence tomography and optical coherence tomography angiography at month 6 postoperatively. The fellow untreated eyes were also examined and served as the control data. A statistically significant enlargement in the foveal avascular zone (FAZ) in both the superficial (p = 0.002) and the deep capillary plexus (p = 0.01) was noticed 6 months postoperatively in patients with RRD treated with PPV compared to the fellow eyes. The foveal avascular zone perimeter was increased in the operated eyes in the deep capillary plexus (p = 0.0003) and the foveal avascular zone circularity was decreased in both the superficial (p = 0.045) and the deep capillary plexus (p < 0.001) compared to the fellow eyes. The vessel density was not significantly different between the operated and the fellow eyes in the superficial and the deep capillary plexus. The vessel density and the foveal avascular zone parameters were comparable between the C3F8 and SF6 groups. Specific microvascular indices as measured by OCTA were statistically different between the operated and the fellow eyes in the superficial and deep capillary plexus. C3F8 and SF6 as gas tamponades did not seem to differ in their impact on the microvascular parameters.

Abstract 11918: Simultaneous Presentation of Pyogenic Pericarditis, Coronavirus Infection, and Endocarditis: A Challenging Triad in a Single Patient

Background: Pyogenic pericarditis is a rapidly progressive infection with high mortality near 100%. In the present antibiotic age, bacterial pericarditis is an uncommon cause of acute pericarditis. The reported incidence of pyogenic pericarditis is less than 1% of all pericarditis cases. Case: 54 year-old male patient that presented with complaints of generalized weakness, fatigue, and fever. He was diagnosed with Coronavirus 229E by PCR. He was in respiratory distress, and CT chest showed concern for large pericardial effusion. Transthoracic echocardiogram showed large pericardial effusion (Image) without tamponade effect. Patient decompensated overnight and bedside point of care ultrasound overnight showed concern for tamponade effect. Pericardial window was performed and 800 ml thick purulent drainage evacuated. While in the ICU patient underwent transesophageal echocardiogram that showed Small hyper-mobile echo-density on the aortic valve concerning for endocarditis (image). Patient also had Type 1 Bicuspid aortic valve with heavily calcified raphe. Cultures on the pericardial effusion grew methicillin sensitive Staphylococcus Aureus. Patient will need 6 weeks of IV antibiotics and aortic valve replacement. Infectious disease recommended lifelong suppression therapy for MSSA. Decision-making: It is not uncommon for bacterial endocarditis and viruses to cause pericardial effusions. It is uncommon for a patient to have bacterial endocarditis, Coronavirus, and be diagnosed with pyogenic pericardial effusion. Cardiac tamponade is a clinical emergency, and evacuation of pericardial fluid to assist reduce the pressure surrounding the heart is used to treat cardiac tamponade. Conclusion: Here we present a case to our knowledge that has never been described before. This is a case of a patient that had infective endocarditis with confirmed Coronavirus that resulted in a pyogenic pericardial effusion.

No Blood Loss Increase in Cementless vs. Cemented Fixation Following Bilateral Total Knee Arthroplasty: A Propensity Score Matching Study.

Background and Objectives: Recent advancements in three-dimensional printing technology have enhanced the biologic fixation of cementless total knee arthroplasty (TKA), therefore increasing the utilization of newer-generation cementless implants. However, the lack of sealing and tamponade effect of cement on the resected bone surface after cementless TKA raises concerns regarding the potential for greater blood loss compared to cemented TKA. The aim of this study was to (1) compare blood loss and transfusion rates between cementless and cemented TKAs and (2) identify the risk factor for higher blood loss in patients who underwent 1-week-interval staggered bilateral (SB) TKA. Materials and Methods: This retrospective, propensity-matched study included 54 cementless and 53 cemented SB TKAs performed by a single surgeon from 2019 to 2023 with a single implant that has similar design features in both cementless and cemented implants. All patients underwent 1-week-interval SB TKA and received the same patient blood management (PBM) and rehabilitation protocol. The estimated total blood loss (TBL), transfusion rate, and total hemoglobin drop were assessed. Patients were categorized according to TBL into average TBL and higher TBL groups. Univariate and multiple logistic regression analyses were performed to identify risk factors for higher blood loss. Results: There was no difference in TBL between cementless and cemented TKA groups (1233 ± 299 and 1282 ± 309 mL, respectively; p > 0.05). In addition, no between-group differences in the transfusion rate and mean total hemoglobin drop were observed. The logistic regression analyses revealed that whether TKA was cementless or cemented was not associated with higher blood loss; rather, the only identified risk factor was the pre-TKA patient blood volume (odd ratio 1.001, 95% confidence interval 1.000-1002, p = 0.026). Conclusions: Contemporary cementless fixation does not increase blood loss or transfusion rates compared to cemented fixation in patients undergoing 1-week-interval staggered bilateral TKA.

MACULAR SLING: A CUSTOMIZABLE METHOD FOR MACULAR BUCKLING USING AVAILABLE ELEMENTS.

Macular buckling surgery is used to treat certain cases of myopic traction maculopathy but is rarely performed in the United States. One of the main factors limiting its use is the lack of commercially available buckling elements. Here, we describe a novel technique for creating an effective macular buckle using readily obtainable buckling materials. By using a traditional circumferential 41 band as the anchoring point around the globe, a 240 band can then be attached and oriented posteriorly along the superonasal-inferotemporal axis. This posterior 240 band is then used to guide a grooved sponge (509G) under the macula to create a customizable and titratable tamponade effect along the posterior pole. This approach was used to provide external support in the case of a recurrent, complex tractional retinal detachment which had failed multiple prior vitrectomy-based repairs. Placement of the macular sling resolved the patient's recurrent retinal detachment with return of the visual acuity to her preoperative baseline. There have been no adverse effects related to the surgery aside from a large hyperopic shift due to the buckle effect on the macula. We believe the technical and material complexity of this technique is comparable with that of more common scleral buckling techniques. This macular sling technique can be used to create an effective posterior buckle without requiring specialized materials.

Efficacy of early intrauterine balloon tamponade for immediate postpartum hemorrhage after vaginal delivery: a randomized clinical trial

Many questions remain about the appropriate use of intrauterine balloon devices in postpartum hemorrhage after vaginal delivery refractory to first-line uterotonics. Available data suggest that early use of intrauterine balloon tamponade might be beneficial. This study aimed to compare the effect of intrauterine balloon tamponade used in combination with second-line uterotonics vs intrauterine balloon tamponade used after the failure of second-line uterotonic treatment on the rate of severe postpartum hemorrhage in women with postpartum hemorrhage after vaginal delivery refractory to first-line uterotonics. This multicenter, randomized, controlled, parallel-group, nonblinded trial was conducted at 18 hospitals and enrolled 403 women who had just given birth vaginally at 35 to 42 weeks of gestation. The inclusion criteria were a postpartum hemorrhage refractory to first-line uterotonics (oxytocin) and requiring a second-line uterotonic treatment with sulprostone (E1 prostaglandin). In the study group, the sulprostone infusion was combined with intrauterine tamponade by an ebb balloon performed within 15 minutes of randomization. In the control group, the sulprostone infusion was started alone within 15 minutes of randomization, and if bleeding persisted 30 minutes after the start of sulprostone infusion, intrauterine tamponade using the ebb balloon was performed. In both groups, if the bleeding persisted 30 minutes after the insertion of the balloon, an emergency radiological or surgical invasive procedure was performed. The primary outcome was the proportion of women who either received ≥3 units of packed red blood cells or had a calculated peripartum blood loss of >1000 mL. The prespecified secondary outcomes were the proportions of women who had a calculated blood loss of ≥1500 mL, any transfusion, an invasive procedure and women who were transferred to the intensive care unit. The analysis of the primary outcome with the triangular test was performed sequentially throughout the trial period. At the eighth interim analysis, the independent data monitoring committee concluded that the incidence of the primary outcome did not differ between the 2 groups and stopped inclusions. After 11 women were excluded because they met an exclusion criterion or withdrew their consent, 199 and 193 women remained in the study and control groups, respectively, for the intention-to-treat analysis. The women's baseline characteristics were similar in both groups. Peripartum hematocrit level change, which was needed for the calculation of the primary outcome, was missing for 4 women in the study group and 2 women in the control group. The primary outcome occurred in 131 of 195 women (67.2%) in the study group and 142 of 191 women (74.3%) in the control group (risk ratio, 0.90; 95% confidence interval, 0.79-1.03). The groups did not differ substantially for rates of calculated peripartum blood loss pf ≥1500 mL, any transfusion, invasive procedure, and admission to an intensive care unit. Endometritis occurred in 5 women (2.7%) in the study group and none in the control group (P=.06). The early use of intrauterine balloon tamponade did not reduce the incidence of severe postpartum hemorrhage compared with its use after the failure of second-line uterotonic treatment and before recourse to invasive procedures.

Pneumocephalus After Anterior Lumbar Spinal Surgery Due to Trauma: A Case Report

Pneumocephalus as a complication of anterior lumbar spinal surgery is extremely rare. A 53-year-old male patient presented with L4 fracture. Posterior fixation from L3 to L5 was conducted one day after the trauma. As the patient’s neurological deficit persisted, additional anterior surgery by L4 vertebral body replacement was performed on the 19th day. Both surgeries were completed without obvious intraoperative complications. Two weeks after the anterior lumbar surgery, the patient complained of severe headaches, and computed tomography scan revealed pneumocephalus and massive fluid retention in the abdomen. The symptoms improved with conservative treatment, including bed rest, spinal drainage, intravenous drip infusion, and prophylactic administration of antibiotics. Due to the lack of tamponade effect in the soft tissues, a large amount of cerebrospinal fluid leakage may induce and cause progression of pneumocephalus in anterior dural injury.

A Chest Tube Inadvertently Inserted into Tracheal Lumen

The accompanying images demonstrate the presence of the distal end of a chest tube in the tracheal lumen just above the carina. These images are from a patient who developed coughing and massive air leak after chest tube placement. Inadvertent tracheal injury during chest tube placement should heighten suspicion for concomitant lung injury.1 Massive air leak in tracheobronchial disruption leads to low tidal volumes, lung atelectasis, and increased work of breathing. Consequently, respiratory distress may ensue, necessitating urgent intubation. In hemodynamically stable patients, bronchoscopy-guided endotracheal intubation is encouraged. This allows for airway examination, confirmation of tracheal injury site, and determination of the best strategy for achieving lung isolation to facilitate surgical repair.Lung isolation allows for mechanical ventilation of the uninjured lung and helps avoid pressurization of surgical repair site, minimizing risk of further disruption. In patients with bronchial injury, advancing the single-lumen endotracheal tube or placing a double-lumen endotracheal tube into the contralateral uninjured bronchus are possible options. In patients with carinal injury, creation of a large tracheostomy through which small endotracheal tubes are advanced into bilateral main stem bronchi allows delivery of mechanical ventilation while minimizing pressurization of the repaired carina.2 Tenuous cardiopulmonary status before induction of anesthesia or inability to maintain adequate oxygenation during one-lung ventilation may necessitate institution of peripheral extracorporeal membrane oxygenation to facilitate surgical repair. Importantly, removal of the chest tube leads to loss of its tamponade effect on lacerated pulmonary vessels. As this can precipitate massive hemorrhage, it is important to establish invasive arterial monitoring and large-bore intravenous access before anesthesia induction.3The authors declare no competing interests.

Abstract Number ‐ 99: Middle Meningeal Artery Embolization for Acute‐on‐Chronic Subdural Hematomas.

Introduction Chronic subdural hematomas (cSDH) are a challenge in management due to recurrent bleeds caused by focal inflammation and angiogenesis that produces frail vasculature. One intervention under investigation is endovascular embolization of the middle meningeal artery (MMA) for dura de‐vascularization. While there is increasing evidence for its utility, few investigations have been made into its role for acute‐on‐chronic SDHs and the timeline to intervention. Here, we identify 19 patients undergone MMA embolization to highlight preliminary trends in radiological and morbidity outcomes associated with time‐to‐intervention and hematoma size. Methods A retrospective cohort study of 19 patients undergone embolization of the anterior frontal and posterior parietal branches of the MMA for chronic or acute‐on‐chronic SDHs. Data retrieved is presented in Table 1 and includes: presenting symptoms; radiological features; surgical intervention(s); timeline to therapy and embolysate used; and procedural complications and outcomes. Results Preliminary findings suggests greater utility of MMA embolization for large‐sized subdural hematomas or when performed after 3–4 weeks of initial acute‐on‐chronic bleeds. We note 11 patients with complete or near‐complete resolution of the hematoma after several weeks without peri‐procedural complications or post‐surgical recurrence. In four of these cases (patients 7, 9, 18, and 19), there was resolution of the hematoma after only a brief interval of 2–14 days between radiographic evidence of the acute bleed and embolization. In these cases, the hematoma was noted to be considerably large in volume with a maximal width measuring between 18–30mm with resolution after 2–9 weeks post‐embolization. Conversely, we note poor outcomes in 4 cases (patients 6, 12, 13, and 15) when embolization was performed early (i.e. between 2–10 days) for smaller hematomas measuring between 5–12mm in maximal width. Conclusions MMA embolization functions to de‐vascularize capillary‐rich dura membranes to prevent re‐bleeds and allow for resorption of blood. However, the timeline for embolization of acute hematoma bleeds currently remains elusive. Here, we find preliminary evidence that suggests MMA embolization may be most appropriate for acute‐on‐chronic SDHs after a 3–4 week interval since time of radiographic evidence or for those with a large size hematoma when opting to treat sooner.These findings align with current understanding of the rapid angiogenetic formation of capillaries in the subacute phase (i.e. 0–3 weeks) with leaky vessels after the initial traumatic event. Occluding these vessels would prevent constant re‐bleeds and hematoma growth in the subacute phase. Theoretically, this would recede the hematoma, permit its resorption, and reduce angiogenesis. Moreover, in current literature there have been reports of contralateral hematoma formation in patients undergone surgical evacuation of an initial small acute hematoma. A similar pathogenic process may be implicit with an endovascular approach as well in which there is a natural tamponade effect of the larger coagulated chronic ematoma against frail vasculature causing acute bleeds.

Intravitreal air tamponade after AAV2 subretinal injection modifies retinal EGFP distribution

The subretinal injection protocol for the only approved retinal gene therapy (voretigene neparvovec-rzyl) includes air tamponade at the end of the procedure, but its effects on the subretinal bleb have not been described. In the present study, we evaluated the distribution of enhanced green fluorescent protein (EGFP) after subretinal injection of AAV2 in non-human primates (NHP) without (group A= 3 eyes) or with (group B= 3 eyes) air tamponade. The retinal expression of EGFP was assessed 1month after subretinal injection with invivo fundus photographs and fundus autofluorescence. In group A (without air), EGFP expression was limited to the area of the initial subretinal bleb. In group B (with air), EGFP was expressed in a much wider area. These data show that the buoyant force of air on the retina causes a wide subretinal diffusion of vector, away from the injection site. In the present paper, we discuss the beneficial and deleterious clinical effects of this finding. Whereas subretinal injection is likely to become more common with the coming of new gene therapies, the effects of air tamponade should be explored further to improve efficacy, reproducibility, and safety of the protocol.

ROLE OF INNOVATIVE BALLOON TAMPONADE IN ATONIC POST PARTUM HAEMORRHAGE

Introduction: Postpartum hemorrhage is the major cause of maternal deaths, especially in the developing world. Uterine atony is the most common cause of PPH and when the hemorrhage is not controlled with medical management then Intrauterine balloon tamponade is one method that proves very effective and reduces the need for further surgical interventions. T Aims &amp; Objectives: o evaluate the effectiveness of balloon tamponade in the management of atonic PPH. This prospective study was conducte Materials &amp; Methods: d in the Department of Obstetrics &amp; Gynaecology at Government Medical College and Rajendra Hospital, Patiala. We included 50 cases of atonic PPH in the study where medical management failed. Uterine tamponade was achieved by an innovative condom balloon catheter The success rate of balloon tamponade Results: in controlling bleeding came out to be 94%. We concluded that Uterine balloon tam Conclusions: ponade is effective, non-invasive, simple to use, easily available, and cost-effective method for the management of PPH. If we are unable to control bleeding with this method, it provides a temporary tamponade effect to gain time for surgical procedures or referral to a higher center if facilities are not available

Adverse Events of Endoscopic Clip Placement: A MAUDE Database Analysis.

Clips are endoscopic mechanical devices with tensile and closure strength that can approximate tissue and provide hemostasis through a tamponade effect. Clips are ubiquitously used in endoscopic practice, and numerous studies have validated the clinical efficacy of clips, with recent guidelines recommending them as a first-line intervention for recurrent and persistent nonvariceal gastrointestinal bleeding. However, the safety profile for these devices has yet to be delineated, thus, we aim to investigate this feature by examining the adverse events reported to the Food and Drug Administration. Postmarketing surveillance data from the Food and Drug Administration Manufacturer And User Facility Device Experience database were analyzed from January 2012 to January 2021. The Manufacturer And User Facility Device Experience database is a reporting software and does not independently verify the details of complications. Two thousand five hundred forty reports were issued, of which 287 were patient adverse events and 2766 were device problems. Activation, separation, and positioning issues were most common. No consequences or clinically significant impact on patients were seen in 1968 reports. Foreign bodies were seen in 97 cases, hemorrhage in 57 cases, tissue damage in 42 cases, embedded clips in tissues/plaques in 16 cases, perforation in 15 cases, lacerations in 6 cases, and infection in 3 cases. While the most commonly reported device problems involved activation, separation, and positioning, most patients were clinically unaffected. Moreover, perforation and infection were exceedingly rare, further highlighting the safety profile of endoscopic clips.

Search for optimal methods of blood sampling from laboratory rats under conditions of chronic experiment

Purpose: to identify the optimal ways of taking blood from rats in the framework of a chronic experiment.Materials and methods. Two series of studies were conducted, in the first of which a comparative assessment of the diameter of the venipuncture needle was carried out. In the second series, the volume of blood received with and without anticoagulant was determined. The experiment was carried out on male Wistar rats, using butterfly needles with a flexible catheter of various sizes - 23G, 24G and 25G, a 2 ml syringe and heparin diluted with saline in a ratio of 1:10 (500 IU/ml).Results. In a scientific experiment, it was found that the optimal size of the butterfly needle for blood sampling in laboratory rats is G-24 (needle diameter 0.55 mm). Needles with a smaller diameter are not suitable for blood sampling, as a blood clot forms in their lumen, which significantly reduces the volume of blood taken. Butterfly catheters with a large needle diameter (needle diameter 0.6 mm) create the effect of vessel tamponade. The results of the second series of experiments indicate a significant increase in the volume of blood received with the use of an anticoagulant than without it. This is confirmed in the intergroup comparison of the amount of blood obtained in rats of the first group (with the use of anticoagulant) by 46.5 % higher than in the second group (without the use of anticoagulant) (P&lt;0.05).Conclusion. The conducted studies indicate that when taking blood from the tail vein of rats, the optimal size of the butterfly needle was 24G. Also, the use of a heparin solution at a concentration of 500 U / ml made it possible to obtain a blood volume from rats that was 46.5 % higher than without the use of an anticoagulant. The use of this method in practice (a syringe and a G-24 butterfly catheter together with an anticoagulant) actualizes multiple blood sampling in a chronic experiment, reduces the laboriousness of the blood sampling process and minimizes trauma to laboratory animals.

Comparison of air versus perfluoropropane intraocular tamponade combined with vitrectomy for the treatment of macular hole in high myopia.

To compare the efficacy of air and perfluoropropane (C3F8) with pars plana vitrectomy (PPV) in highly myopic macular holes (HMMH), and explore the factors related to surgical prognosis. A retrospective comparison of a consecutive series of HMMHs undergone PPV and internal limiting membrane (ILM) peeling. According to tamponade type, they were divided into air group and C3F8 group, which were further divided into subgroups based on hole diameter or axial length (AXL). Anatomical and functional outcome were compared between tamponades. Related factors of initial closure rate and postoperative best-corrected visual acuity (BCVA) were analyzed by logistic regression. The baseline characteristics in air group (n=63) and C3F8 group (n=37) were similar except the age of air was older (P=0.019). The mean follow-up period was 17.16 ± 17.97 months. After surgery, the initial closure rate of air group was 85.7% and that of C3F8 group was 83.7% (P=0.780). And the initial closure rate showed no difference between tamponades in the same subgroup classified by hole diameter or AXL (All P>0.05). Postoperative BCVA improved significantly in both groups (P<0.001), but no difference between them (P=0.793). Logistic regression showed age, MLD and AXL were risk factors of initial closure rate, and preoperative BCVA was the only factor associated with postoperative BCVA (all P<0.05). With a long-term follow-up of HMMH, we found air had a similar tamponade effect anatomically and functionally compared with C3F8. Air may also be a good choice for patients with HMMH.

Effect of Silicon Oil Tamponade and Its Removal on Central Macular Thickness in Cases of Rhegmatogenous Retinal Detachment Using Swept Source OCT

Purpose: To evaluate the effect of silicone oil (SO) tamponade and its removal on central macular thickness (CMT) and average macular thickness (AMT). Study Design: Quasi experimental study. Place &amp; Duration of Study: Jinnah Postgraduate Medical Centre, Karachi, from June 2021 to April 2022. Methods: A total of 27 patients with 27 eyes with rhegmatogenous retinal detachment were included. Pars Plana Vitrectomy (PPV) with SO tamponade was performed. Removal of silicon oil (ROSO) was performedafter six months. Optical Coherence Tomography (OCT) was done before PPV, one month after PPV and one month after ROSO. The Central macular thickness (CMT) and Average macular thickness (AMT) were measured and compared between operated and control eyes. Results: The mean CMT and AMT before surgery was 230 ± 60.5 μm and 253.3 ± 40.3 μm respectively. The mean CMT one month after PPV with SO was 281 ± 62.8 μm and 232 ± 62.2 μm in the operated eyes and control eyes (p = 0.053). Mean AMT one month after PPV with SO was 294 ± 98.7 μm and 253 ± 37.0 μm in operated and control eyes (p = 0.182). Mean CMT one month after SO removal was 222 ± 81.5 μm in operated eyes and 230 ± 59.2 μm in control eyes (p = 0.056). Mean AMT one month after SO removal was 263 ± 45.0 μm in operated eyes and 254 ± 21.4 μm in the control eyes (p = 0.087). Conclusion: There was no statistically significant difference in the CMT and AMT before and after silicone oil tamponade and its removal, in patients with Rhegmatogenous Retinal Detachment.

Unveiling the causes of pericardial effusion in a contemporary case series of pericardiocentesis in Latin America

Pericardial effusions requiring pericardiocentesis have multiple causes that vary among geographical regions and health contexts. This procedure can be performed for diagnostic or therapeutic indications. The purpose of this study was to identify the principal causes of pericardial effusions and indications for pericardiocentesis, exploring differences among groups. This was a retrospective case series of patients who underwent pericardiocentesis for pericardial effusion in a single center in Latin America. Demographic, clinical, echocardiographic, and procedural variables were recorded and analyzed. The primary outcome was to determine the causes of pericardial effusions in these patients and the indication (diagnostic, therapeutic, or both). The results are presented in two groups (inflammatory and noninflammatory) according to the cause of the pericardial effusion. One hundred sixteen patients with pericardial effusion underwent pericardiocentesis. The median age was 58 years (IQR 46.2–70.7), and 50% were male. In the noninflammatory pericardial effusion group, there were 61 cases (53%), among which neoplastic pericardial effusion was the most frequent cause (n = 25, 40.9%). In the inflammatory group, there were 55 cases (47%), and the main cause was postpericardiectomy syndrome after cardiac surgery (n = 31, 56.4%). The principal indication for pericardiocentesis was therapeutic (n = 66, 56.8%). Large pericardial effusion without hemodynamic effect of cardiac tamponade was significantly more frequent in the inflammatory group (p = 0.03). In conclusion, the principal cause of pericardial effusion in patients who underwent pericardiocentesis was postpericardiectomy syndrome after cardiac surgery, followed by neoplastic pericardial effusion. Pericardiocentesis is mainly a therapeutic procedure.

Outcome of Joint Aspiration in Acute Knee Haemarthrosis in a Haemophilic Joint: A Prospective Randomised Controlled Trial in 120 Patients in a Tertiary Haemophilia Care Centre.

Bleeding into the joints cause major morbidity in haemophilia patients. The clinical hallmark of haemophilia is haemarthrosis especially in knee, ankle and elbow joint. Current literature suggests that aspiration of an acute haemarthrosis in haemophilia may lead to further bleeding and prevent tamponade effect. But the rehabilitation gets delayed, leading to joint stiffness and the function gets deteriorated. This study was done to evaluate the efficacy of joint aspiration in the management of acute knee haemarthrosis, with regard to pain relief and functional outcome. This is a prospective, randomised controlled trial in a tertiary care haemophilia treatment centre comprising 120 haemophilic patients with unilateral acute knee haemarthrosis. Factor level was checked and appropriate factor replacement [40%] was done. The patients were randomly allocated in two groups: Group A and Group B, each consisting of 60 patients. All patients received ice application, limb immobilisation, analgesics, physiotherapy and compression bandage as the routine primary management. In addition, study Group A also received therapeutic aspiration of the knee joint at initial presentation, after the first factor infusion. All patients were clinically evaluated for pain in terms of Visual Analogue Scale (VAS score) and function in terms of Haemophilic Joint Health Score [HJHS], before and at 4h, 48h and 7days after initial factor administration. All patients showed therapeutic improvement in terms of a declining trend in VAS and HJHS scores. Pain relief (VAS Score) in Group A, was found to be significantly better compared to Group B at the end of 4h [4.80 ± 0.49 vs 6.54 ± 1.05; p < 0.001], 48h [2.48 ± 0.50 vs 3.30 ± 0.46; p < 0.001] and 7days [1.16 ± 0.37 vs 1.70 ± 0.46; p < 0.001]. Functional improvement (HJHS Score) in Group A, was found to be significantly better compared to Group B as well at the end of 4h [11.24 ± 0.77 vs 14.52 ± 0.61; p < 0.001], 48h [7.24 ± 0.65 vs 11.28 ± 0.64; p < 0.001] and 7days [2.36 ± 0.48 vs 5.52 ± 0.67; p < 0.001]. Our study recommends the use of joint aspiration as a therapeutic tool in the holistic management of acute knee haemarthrosis in addition to usual treatment of ice application, immobilization and oral tranexamic acid. Early factor replacement along with therapeutic joint aspiration is a key for better pain relief and a better functional outcome.

Efficacy of Combination Therapy with Epinephrine Local Injection and Hemostatic Clips on Active Diverticular Bleeding.

Epinephrine local injection is a hemostatic procedure used in active diverticular bleeding that elicits vasoconstriction and tamponade effects. We compared the additional benefit of combination therapy with HSE-C (hypertonic saline epinephrine injection with clipping) to clipping monotherapy. Retrospective data on diverticular bleeding between 2011 and 2016 was reviewed. Those with an active bleeding source confirmed by colonoscopy (excluding non-bleeding vessels and adherent clots) who received either HSE-C or clipping were evaluated. Endpoints were rates of successful primary hemostasis, recurrent bleeding, and surgical intervention during hospitalization. A total of 320 patients with diverticular bleeding were evaluated, on which either HSE-C (n = 35) or clipping monotherapy (n = 18) was performed. Rates of successful primary hemostasis (91.4% vs. 66.7%, p = 0.048) and direct placement of endoclips (60.0% vs. 16.7%, p = 0.004) were significantly higher in the HSE-C group. Although not statistically significant, the HSE-C group had a higher rate of early rebleeding (18.8% vs. 8.3%, p = 0.653), while no difference was seen in the number of patients requiring surgery (11.4% vs. 5.5%, p = 0.651). HSE-C is associated with a higher rate of successful primary hemostasis for severe active diverticular bleeding but has no significant difference in reducing early recurrent bleeding or the number of patients requiring surgery, suggesting that hemostatic effects may be temporary.