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Journal of Medical Imaging and... Jun 2023High-flow priapism is a rare condition with limited data in the literature, particularly in Australia. There is therefore no clear consensus regarding treatment. We aim...
INTRODUCTION
High-flow priapism is a rare condition with limited data in the literature, particularly in Australia. There is therefore no clear consensus regarding treatment. We aim to present our institutional network experience in managing this condition over the last decade with super-selective gelatin sponge (Gelfoam) embolisation of the internal pudendal artery.
METHODS
We retrospectively searched for and reviewed the patient records of all cases of priapism encountered within our multicentre institutional network over the last 10 years. Of these, the cases of high-flow priapism treated with embolisation were analysed in depth and compared with the current literature.
RESULTS
Overall, 93 patients in our network were diagnosed with priapism from 1 January 2012 to 1 January 2022. And 89 of these patients (96%) had low-flow priapism and four patients (4%) had high-flow priapism. Of these four patients, two were treated within our network with super-selective Gelfoam embolisation of the internal pudendal artery. Following embolisation, both patients achieved rapid detumescence and returned to baseline premorbid erectile function. There was no report of recurrence or erectile dysfunction on follow-up.
CONCLUSION
Super-selective embolisation of the internal pudendal artery should be considered as a treatment option for high-flow priapism, with Gelfoam as an appropriate temporary embolic agent of choice. We show that it was a safe and effective option for the patients treated in this series, enabling quick and long-term return to baseline erectile function. Our results support data provided by the limited number of cases in the literature.
Topics: Male; Humans; Priapism; Erectile Dysfunction; Gelatin Sponge, Absorbable; Retrospective Studies; Penis; Embolization, Therapeutic
PubMed: 36203271
DOI: 10.1111/1754-9485.13482 -
Der Chirurg; Zeitschrift Fur Alle... Jan 2022Anastomotic insufficiency and perforations in the gastrointestinal tract are severe complications associated with a high complication rate and mortality. Conventional... (Review)
Review
BACKGROUND
Anastomotic insufficiency and perforations in the gastrointestinal tract are severe complications associated with a high complication rate and mortality. Conventional treatment options (particularly re-operations) are often unsatisfactory. Endoscopic vacuum therapy (EVT) is increasingly being used as a promising alternative.
PROBLEM
The use of EVT requires a high level of competence in interventional flexible endoscopy, which is primarily not available to every surgeon. Special training programs are required here.
METHODS
Based on this need the long-proven Tuebingen training system for flexible endoscopy was modified to meet the special requirements of surgeons and is currently being extended by a special training module for EVT.
RESULTS
In addition to the theoretical principles, the training is focused on learning the manual skills for flexible endoscopy. A 2-stage process was developed for this purpose: 1) to become familiar with handling of the flexible endoscope and to learn spatial orientation by means of a didactically optimized abstract phantom ("Tuebingen Orientophant") and 2) learning and training of EVT using a newly developed patient-analogous training model with various insufficiencies and abscess cavities in the upper and lower gastrointestinal tract ("Tuebinger Spongiophant"). The procedure can be trained hands-on step by step exactly as with the patient, whereby the sponge can be applied using different methods, such as overtube and dragging procedures. The consequences of mistakes and complication management can also ideally be trained hands-on using the phantom.
DISCUSSION
Evaluations of the first course series show that surgeons achieve endoscopic competence very quickly and learn to master the new procedure. The structure of such a course must, however, be designed according to long-term experience in an optimal didactic manner. Decision-makers in healthcare policy should give much more support to such courses in order to improve patient care and to increase patient safety.
Topics: Anastomotic Leak; Endoscopes; Endoscopy; Humans; Negative-Pressure Wound Therapy; Vacuum
PubMed: 34570261
DOI: 10.1007/s00104-021-01497-4 -
International Journal of Surgery Case... Feb 2022Gossypiboma is defined as developing an exudative inflammatory process around retained foreign bodies (RFBs). This problem may be asymptomatic or present with severe...
INTRODUCTION AND IMPORTANCE
Gossypiboma is defined as developing an exudative inflammatory process around retained foreign bodies (RFBs). This problem may be asymptomatic or present with severe systemic or regional symptoms. Traditionally, every RFB must be removed with a surgical procedure. In the era of minimally invasive surgery, laparoscopic removal is a good choice for these problems.
CASE PRESENTATION
A young woman was referred to us with intermittent vague abdominal pain and a history of open cholecystectomy. After initial imaging, we found a twisted string-like object in epigastrium. Considering clinical findings and imaging, the patient was taken to the operating room with a diagnosis of RFB. After an explorative laparoscopy, we found an encapsulated fibrotic mass around a surgical sponge with pus-like secretions.
CONCLUSION
After diagnosing either RFB or gossypiboma, surgical intervention is mandatory, even in asymptomatic patients. Laparoscopy can help the surgeon to remove the retained item safely. Also, decreased length of stay and postoperative pain are significant advantages of laparoscopic removal.
PubMed: 35093706
DOI: 10.1016/j.ijscr.2022.106799 -
Molecular Cancer Dec 2021Circular RNAs (circRNAs) have been indicated as potentially critical mediators in various types of tumor progression, generally acting as microRNA (miRNA) sponges to...
BACKGROUND
Circular RNAs (circRNAs) have been indicated as potentially critical mediators in various types of tumor progression, generally acting as microRNA (miRNA) sponges to regulate downstream gene expression. However, the aberrant expression profile and dysfunction of circRNAs in human clear cell renal cell carcinoma (ccRCC) need to be further investigated. This study mined key prognostic circRNAs and elucidates the potential role and molecular mechanism of circRNAs in regulating the proliferation and metastasis of ccRCC.
METHODS
circCHST15 (hsa_circ_0020303) was identified by mining two circRNA microarrays from the Gene Expression Omnibus database and comparing matched tumor versus adjacent normal epithelial tissue pairs or matched primary versus metastatic tumor tissue pairs. These results were validated by quantitative real-time polymerase chain reaction and agarose gel electrophoresis. We demonstrated the biological effect of circCHST15 in ccRCC both in vitro and in vivo. To test the interaction between circCHST15 and miRNAs, we conducted a number of experiments, including RNA pull down assay, dual-luciferase reporter assay and fluorescence in situ hybridization.
RESULTS
The expression of circCHST15 was higher in ccRCC tissues compared to healthy adjacent kidney tissue and higher in RCC cell lines compared to normal kidney cell lines. The level of circCHST15 was positively correlated with aggressive clinicopathological characteristics, and circCHST15 served as an independent prognostic indicator for overall survival and progression-free survival in patients with ccRCC after surgical resection. Our in vivo and in vitro data indicate that circCHST15 promotes the proliferation, migration, and invasion of ccRCC cells. Mechanistically, we found that circCHST15 directly interacts with miR-125a-5p and acts as a microRNA sponge to regulate EIF4EBP1 expression.
CONCLUSIONS
We found that sponging of miR-125a-5p to promote EIF4EBP1 expression is the underlying mechanism of hsa_circ_0020303-induced ccRCC progression. This prompts further investigation of circCHST15 as a potential prognostic biomarker and therapeutic target for ccRCC.
Topics: Adaptor Proteins, Signal Transducing; Adult; Aged; Animals; Biomarkers, Tumor; Carcinoma, Renal Cell; Cell Cycle Proteins; Cell Line, Tumor; Disease Models, Animal; Female; Gene Expression Regulation, Neoplastic; Heterografts; Humans; Kidney Neoplasms; Male; Membrane Glycoproteins; Mice; MicroRNAs; Middle Aged; Models, Biological; Neoplasm Grading; Neoplasm Staging; Prognosis; RNA Interference; RNA, Circular; Sulfotransferases
PubMed: 34922539
DOI: 10.1186/s12943-021-01449-w -
International Journal of Surgery Case... Aug 2022Textilloma or Gossypiboma refers as surgical sponges left behind in the surgical field during surgery. Although rare, occur commonly in practice and such cases are...
INTRODUCTION AND IMPORTANCE
Textilloma or Gossypiboma refers as surgical sponges left behind in the surgical field during surgery. Although rare, occur commonly in practice and such cases are rarely encountered in the literature due to their under-reporting. A retained surgical sponge is an avoidable surgical complication that can lead to patient morbidity, mortality and profound medico-legal implications.
CASE PRESENTATION
We report a case of intra-abdominal textiloma discovered early in a 31-year-old woman who underwent cesarean section due to placenta previa.
DISCUSSION
This complication in our surgical practice is still relevant despite the popularization of the World Health Organization checklist.
CONCLUSION
The purpose of reporting this case is to awaken practitioners to be more vigilant and avoid such circumstances.
PubMed: 35914478
DOI: 10.1016/j.ijscr.2022.107439 -
Annals of Vascular Surgery Jan 2022Deep-space surgical site infections carry significant morbidity and mortality. The evidence for gentamicin-containing collagen implants at reducing surgical site... (Observational Study)
Observational Study
BACKGROUND
Deep-space surgical site infections carry significant morbidity and mortality. The evidence for gentamicin-containing collagen implants at reducing surgical site infections in open infrainguinal arterial surgery is limited. This study examined whether gentamicin-containing collagen implants reduces 30-day surgical site infections and their severity following open infrainguinal arterial surgery.
METHODS
A retrospective observational cohort study that included all patients undergoing infrainguinal arterial bypass or endarterectomy between November 2015 and March 2019 at a single tertiary vascular unit. Patients with contaminated/infected surgical fields, surgical wounds treated with negative pressure therapy, or the usage of antimicrobial implants and dressings other than Collatamp G (Aralez Pharmaceuticals, Canada) were excluded. Patients with gentamicin-containing collagen implants placed abutting vasculature were compared against patients without gentamicin-containing collagen implants. Outcomes included the rate of surgical site infections and their severity within 30 days after the operation.
RESULTS
In 159 procedures (mean age 67.7 years, 74.8% male, 33.3% diabetic, 16.4% chronic renal failure, 25.2% anticoagulated postoperatively, 32.7% with prosthetic implants), 55 (34.6%) procedures received gentamicin-containing collagen implants. There were significantly more males (85.5% vs. 69.2%; P = 0.025), higher rates of obesity (41.8% vs. 26.0%; P = 0.041), and hyperlipidemia (65.5% vs. 49.0%; P = 0.048) in the gentamicin-containing collagen implant group. In total, 6 (3.8%) procedures developed deep-space surgical site infections (1 with gentamicin-containing collagen implant, 5 without) and 13 (8.2%) had severe surgical site infections that required re-intervention (1 with gentamicin-containing collagen implant, 12 without). On logistic regression analysis, the absence of gentamicin-containing collagen implants statistically significantly increased the odds of overall surgical site infections (OR = 2.50; 95% CI 1.01 - 6.19; P = 0.047). There was no statistically significant difference in the odds of deep-space surgical site infections or the severity and need for reintervention of surgical site infections.
CONCLUSIONS
This is the first study that examined the effect of gentamicin-containing collagen implants on the severity of surgical site infections in vascular surgery. Gentamicin-containing collagen implants may reduce the odds of overall surgical site infections. It did not reduce the odds of deep-space surgical site infections or the severity and reintervention rate of surgical site infections following infrainguinal arterial revascularization. Larger studies are required to achieve adequate power to assess for these outcomes.
Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Arterial Occlusive Diseases; Diabetes Complications; Female; Gentamicins; Humans; Ischemia; Lower Extremity; Male; Middle Aged; Obesity; Plastic Surgery Procedures; Retrospective Studies; Risk Factors; Surgical Sponges; Surgical Wound Infection; Vascular Surgical Procedures
PubMed: 34543713
DOI: 10.1016/j.avsg.2021.06.036 -
World Journal of Gastroenterology Apr 2022Endoluminal vacuum-assisted therapy (EVT) has been introduced recently to treat colorectal anastomotic leaks in clinically stable non-peritonitic patients. Its... (Review)
Review
Endoluminal vacuum-assisted therapy (EVT) has been introduced recently to treat colorectal anastomotic leaks in clinically stable non-peritonitic patients. Its application has been mainly reserved to low colorectal and colo-anal anastomoses. The main advantage of this new procedure is to ensure continuous drainage of the abscess cavity, to promote and to accelerate the formation of granulation tissue resulting in a reduction of the abscess cavity. The reported results are promising allowing a higher preservation of the anastomosis when compared to conventional treatments that include trans-anastomotic tube placement, percutaneous drainage, endoscopic clipping of the anastomotic defect or stent placement. Nevertheless, despite this procedure is gaining acceptance among the surgical community, indications, inclusion criteria and definitions of success are not yet standardized and extremely heterogeneous, making it difficult to reach definitive conclusions and to ascertain which are the real benefits of this new procedure. Moreover, long-term and functional results are poorly reported. The present review is focused on critically analyzing the theoretical benefits and risks of the procedure, short- and long-term functional results and future direction in the application of EVT.
Topics: Abscess; Anastomosis, Surgical; Anastomotic Leak; Colorectal Neoplasms; Drainage; Humans; Negative-Pressure Wound Therapy
PubMed: 35582677
DOI: 10.3748/wjg.v28.i14.1394 -
Contact Dermatitis Aug 2019
Topics: Adult; Dermatitis, Allergic Contact; Dermatitis, Occupational; Gloves, Surgical; Guanidines; Hand Dermatoses; Hand Disinfection; Humans; Male; Odorants; Surgeons; Surgical Sponges
PubMed: 30891773
DOI: 10.1111/cod.13270 -
Cureus Oct 2023Surgical training is a long process that requires a lot of commitment and effort. Basic surgical techniques are the foundation of every procedure, with suturing being...
Surgical training is a long process that requires a lot of commitment and effort. Basic surgical techniques are the foundation of every procedure, with suturing being one of them. Hence, it is of great importance for aspiring young surgeons to practice and develop their suturing skills. Quite many kinds of suturing training models have been used and proposed worldwide, ranging from commercial silicone pads to meat leftovers and various fruits. We have developed our own, simplified, and low-cost suturing training pad that consists of three layers and is based on the combined use of silicone sponge sheet and polyurethane foam. It is quite durable and elastic and has been applied in three suturing training workshops so far. For this reason, we would like to present our experience of a low-cost but effective way of promoting and achieving further surgical excellence.
PubMed: 38021872
DOI: 10.7759/cureus.47330 -
International Journal of Biological... Dec 2020Silk fibroin (SF) is derived from Bombyx mori silkworm cocoons and has been used in textiles and as a suture material for decades. More recently, SF has been used for... (Comparative Study)
Comparative Study Review
Silk fibroin (SF) is derived from Bombyx mori silkworm cocoons and has been used in textiles and as a suture material for decades. More recently, SF has been used for various new biomedical applications, including as a wound dressing, owing to its excellent biological and mechanical properties. Specifically, the mechanical stiffness, versatility, biocompatibility, biodegradability, water vapour permeability and slight bactericidal properties make SF an excellent candidate biomaterial for wound dressing applications. The effectiveness of SF as a wound dressing has been tested and well-documented in vitro as well as in-vivo, as described here. Dressings based on SF are currently used for treating a wide variety of chronic and acute (e.g. burn) wounds. SF and its derivatives prepared as biomaterials are available as sponges, hydrogels, nanofibrous matrices, scaffolds, micro/nanoparticles, and films. The present review discusses the potential role of SF in wound dressing and its modulation for wound dressing applications. The comparison of SF based dressings with other natural polymers understands the readers, the scope and limitation of the subject in-depth.
Topics: Animals; Bandages; Bandages, Hydrocolloid; Biocompatible Materials; Biopolymers; Chemical Phenomena; Fibroins; Humans; Hydrogels; Manufactured Materials; Materials Testing; Nanostructures; Polyvinyl Alcohol; Rats; Rats, Sprague-Dawley; Silk; Surgical Sponges; Wound Healing; Zinc Oxide
PubMed: 32814099
DOI: 10.1016/j.ijbiomac.2020.08.041