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HNO Feb 2019Postoperative periorbital edema and ecchymosis after rhinoplasty are mainly caused by the osteotomy with hammer and chisel. The introduction of piezoelectric surgery...
BACKGROUND
Postoperative periorbital edema and ecchymosis after rhinoplasty are mainly caused by the osteotomy with hammer and chisel. The introduction of piezoelectric surgery could lead to a better early postoperative outcome due to improved preservation of soft tissues. The aim of this systematic review was to evaluate the methods and results of studies comparing conventional osteotomy to piezoelectric osteotomy.
METHODS
A systematic literature search was conducted in the PubMed/MEDLINE and Google Scholar databases. In the primary selection, all studies on the comparison of conventional and piezoelectric osteotomies with regard to postoperative periorbital edema and/or ecchymosis were identified. Secondary selection included only study designs with a control group.
RESULTS
Primary selection resulted in 15 thematically relevant publications with a notable increase in annual publications between 2007 and 2017. Six studies with control groups were selected secondarily. Qualitatively and methodologically, the studies were very heterogeneous. The results of five of the six studies indicated a significant advantage of piezo technology compared to conventional osteotomy. Only in one study was no significant difference found in the investigated postoperative outcome.
CONCLUSION
Piezoelectric osteotomy resulted in a reduced propensity for postoperative edema and ecchymosis compared to the conventional osteotomy technique with a chisel. At this time, the results should be regarded as a trend. A definite recommendation favoring piezoelectric osteotomy cannot be made until more studies with higher patient numbers become available.
Topics: Ecchymosis; Edema; Humans; Osteotomy; Piezosurgery; Postoperative Complications; Rhinoplasty
PubMed: 30649568
DOI: 10.1007/s00106-018-0606-2 -
Aesthetic Surgery Journal Jun 2016Despite its increasing usage of facial applications, there is a paucity of objective data regarding calcium hydroxylapatite (CaHA). (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Despite its increasing usage of facial applications, there is a paucity of objective data regarding calcium hydroxylapatite (CaHA).
OBJECTIVES
To systematically evaluate the complications from CaHA injection for facial soft tissue augmentation.
METHODS
Published studies on CaHA injection for facial soft tissue enhancement were identified through searches of the PubMed, EMBASE, and Cochrane Controlled Trial databases. Only randomized, controlled trials comparing CaHA injection to either placebo or an active comparator for facial cosmetic use were included. The outcome measures were the count (n) and frequency (%) of each complication, including edema (swelling), erythema (redness), ecchymosis (bruising), pain, pruritus (itching), hematomas, nodules, and extrusions.
RESULTS
Four studies on nasolabial fold (NLF) injection of CaHA consisting of two subgroups were included: (i) a CaHA-lidocaine vs CaHA subgroup and (ii) a CaHA vs hyaluronic acid (HA) subgroup. The addition of lidocaine to CaHA therapy displayed no significant effect on edema (RR (95% CI): 1.07 (0.94-1.21), P = .311), erythema (RR (95% CI): 0.91 (0.66-1.24), P = .544), ecchymosis (RR (95% CI): 1.04 (0.71-1.52), P = .843), pain (RR (95% CI): 0.88 (0.58-1.33), P = .553), or pruritus (RR (95% CI): 0.82 (0.45-1.50), P = .515). There was no significant difference between CaHA vs HA for hematomas (RR (95% CI): 0.24 (0.01-4.31), P = .332) or nodules (RR (95% CI): 0.18 (0.01-6.62), P = .353). There was no significant publication bias detected in either subgroup (Begg's test P > 0.05).
CONCLUSIONS
These findings support the addition of lidocaine to NLF injection of CaHA and suggest an equivalence between CaHA and HA with respect to hematoma and nodule formation. LEVEL OF EVIDENCE 2: Risk.
Topics: Anesthetics, Local; Biocompatible Materials; Cosmetic Techniques; Durapatite; Humans; Injections; Lidocaine; Nasolabial Fold; Pain; Randomized Controlled Trials as Topic; Skin Aging
PubMed: 27178901
DOI: 10.1093/asj/sjv206 -
Medicina (Kaunas, Lithuania) Nov 2021: Breast mass lesions are common; however, determining the malignant potential of the lesion can be ambiguous. Recently, to evaluate breast mass lesions, vacuum-assisted... (Review)
Review
: Breast mass lesions are common; however, determining the malignant potential of the lesion can be ambiguous. Recently, to evaluate breast mass lesions, vacuum-assisted excision (VAE) biopsy has been widely used for both diagnostic and therapeutic purposes. This study aimed to investigate the therapeutic role of VAE. : Relevant articles were obtained by searching PubMed and EMBASE on 3 September 2021. Meta-analyses were performed using odds ratios and proportions. To assess heterogeneity, we conducted a subgroup analysis and meta-regression tests. : Finally, 26 studies comprising 18,170 patients were included. All of these were observational studies. The meta-analysis showed that the complete resection rate of VAE was 0.930. In the meta-regression test, there was no significant difference. The meta-analysis showed a recurrence rate of 0.039 in the VAE group. The meta-regression test showed no statistical significance. Postoperative hematoma, pain, and ecchymosis after VAE were 0.092, 0.082, and 0.075, respectively. : VAE for benign breast lesions showed favorable outcomes with respect to complete resection and complications. This meta-analysis suggested that VAE for low-risk benign breast lesions is a reasonable option for both diagnostic and therapeutic purposes.
Topics: Biopsy, Needle; Breast; Breast Neoplasms; Female; Humans; Image-Guided Biopsy; Retrospective Studies; Vacuum
PubMed: 34833479
DOI: 10.3390/medicina57111260 -
Cephalalgia : An International Journal... Nov 2016Background Head pain is a cardinal feature of primary headache disorders (PHDs) and is often accompanied by autonomic and vasomotor symptoms and/or signs. Spontaneous... (Meta-Analysis)
Meta-Analysis Review
Background Head pain is a cardinal feature of primary headache disorders (PHDs) and is often accompanied by autonomic and vasomotor symptoms and/or signs. Spontaneous extracranial hemorrhagic phenomena (SEHP), including epistaxis, ecchymosis, and hematohidrosis (a disorder of bleeding through sweat glands), are poorly characterized features of PHDs. Aim To critically appraise the association between SEHP and PHDs by systematically reviewing and pooling all reports of SEHP associated with headaches. Methods Advanced searches using the PubMed/MEDLINE, Web of Science, Cochrane Library, Google Scholar, and ResearchGate databases were carried out for clinical studies by combining the terms "headache AND ecchymosis", "headache AND epistaxis", and "headache AND hematohidrosis" spanning all medical literature prior to October 10, 2015. Preferred Reporting Items for Systematic Reviews and Meta-analyses and Meta-analysis of Observational Studies in Epidemiology guidelines were applied. Results A total of 105 cases of SEHP associated with PHDs (83% migraine and 17% trigeminal autonomic cephalgias) were identified (median age 27 years, male to female ratio 1:2.3); 63% had epistaxis, 33% ecchymosis, and 4% hematohidrosis. Eighty-three percent of studies applied the International Classification of Headache Disorders diagnostic criteria. Eighty percent of the reported headaches were episodic and 20% were chronic. Twenty-four percent of studies reported recurrent episodes of SEHP. Conclusions Our results suggest that SEHP may be rare features of PHDs. Future studies would benefit from the systematic characterization of these phenomena.
Topics: Adult; Age Distribution; Causality; Ecchymosis; Epistaxis; Female; Headache Disorders, Primary; Humans; Male; Middle Aged; Prevalence; Risk Factors; Sex Distribution; Sweat Gland Diseases; Young Adult
PubMed: 26611681
DOI: 10.1177/0333102415618951 -
Journal of Vascular Surgery. Venous and... Nov 2019Endovenous thermal ablation (TA) offers an effective initial treatment option for superficial venous incompetence of the lower limb. These techniques offer lower... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Endovenous thermal ablation (TA) offers an effective initial treatment option for superficial venous incompetence of the lower limb. These techniques offer lower complication rates with similar efficacy to traditional open surgery. In recent years, nonthermal ablation (NTA) in the form of mechanochemical ablation and cyanoacrylate vein ablation has been suggested to further reduce perioperative morbidity. This study aimed to compare the use of both thermal and nonthermal endovenous ablative techniques in the management of superficial venous incompetence.
METHODS
A search of online databases including MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane database was last performed in January 2019. Comparative studies comparing NTA with TA were included. The primary outcome was technical success. Secondary outcomes included operative pain, complications, modification of disease severity, and quality of life.
RESULTS
Six studies describing the outcomes of 1236 participants and 1256 truncal ablations were included for analysis. Follow-up ranged from 6 weeks to 36 months. With regard to overall technical success, 458 of 483 (94.8%) receiving NTA and 521 of 553 (94.2%) undergoing TA had successful truncal ablation on follow-up ultrasound imaging at the study end point (pooled risk ratio, 1.01; 95% confidence interval [CI], 0.99-1.04). Subgroup analysis identified no difference in success between groups during immediate, 6-month, 12-month, or >12-month follow-up periods. Postprocedural pain was generally lower in those undergoing NTA with a mean difference of -18.11 (95% CI, -36.7 to 0.48). Techniques experienced significatly lower rates of ecchymosis (risk ratio, 0.43; 95% CI, 0.23-0.78), with no difference identified with regard to rates of paresthesia, phlebitis, and skin pigmentation. Further assessment of quality of life (mean difference, -0.27; 95% CI, -0.57 to 0.04) and Venous Clinical Severity Score (-0.52; 95% CI, -1.05 to 0.01) revealed no difference between groups. Included data were deemed of moderate methodologic quality.
CONCLUSIONS
Nonthermal techniques are as effective as standard TA in the first year and, in some studies, may be associated with less procedural pain. These data suggest that NTA offers an alternative and safe means to treat superficial venous disease. There is, however, a need for further powered trials with larger numbers of patients and longer follow-up to definitively examine this hypothesis.
Topics: Ablation Techniques; Embolization, Therapeutic; Endovascular Procedures; Humans; Postoperative Complications; Risk Factors; Treatment Outcome; Varicose Veins; Venous Insufficiency
PubMed: 31627874
DOI: 10.1016/j.jvsv.2019.06.009 -
Medicine Feb 2022Pneumatic tourniquets are widely used in total knee arthroplasty (TKA). Some surgeons prefer a uniform tourniquet inflation pressure (UTIP) for all patients; others use... (Meta-Analysis)
Meta-Analysis
Personalized tourniquet pressure may be a better choice than uniform tourniquet pressure during total knee arthroplasty: A PRISMA-compliant systematic review and meta-analysis of randomized-controlled trials.
BACKGROUND
Pneumatic tourniquets are widely used in total knee arthroplasty (TKA). Some surgeons prefer a uniform tourniquet inflation pressure (UTIP) for all patients; others use personalized tourniquet inflation pressures (PTIP) based on systolic blood pressure and limb occlusion pressure. However, no consensus exists regarding the optimal mode of inflation pressure during TKA. This review aimed to appraise if personalized tourniquet inflation pressures are better than uniform tourniquet inflation.
METHODS
The databases (Web of Science, Embase, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, Wanfang) were searched on March 2021 to systematically identify and screen the literature for randomized controlled trials involving PTIP and UTIP during total knee arthroplasty.
RESULTS
Thirteen randomized controlled trials, involving 1204 TKAs (1201 patients) were included in the systematic review. The meta-analysis identified a trend toward less visual analogue scale (VAS) score at rest with PTIP group at 1 day (P = .002), 2 to 3 days (P = .01), and less VAS score at activity 1 day (P < .0001), 2 to 3 days after the operation (P < .00001), and discharge (P < .0001). No significant difference was found between the groups in terms of VAS score at rest when discharge (P = 1.0). We also found no significant difference in terms of intraoperative blood loss (P = .48), total blood loss (P = .15), lower limb vein thrombosis (P = .42), and thigh bullae (P = .17). However, in the PTIP group, we found a significant higher hospital for special surgery (HSS) score (P = .007), broader knee Range of motion (P = .02), less rate of thigh ecchymosis (P = .00001), and shorter thigh circumference at 1 day (P = .006), 2 to 3 days (P = .0005), and discharge (P = .02).
CONCLUSION
PTIP provides a similar bloodless surgical field compared with the conventional UTIP. Furthermore, PTIP provides less pain intensity, thigh circumference, rate of thigh ecchymosis, higher hospital for special surgery, and better initial recovery of knee flexion in total knee arthroplasty. Therefore, we recommend using a PTIP method during TKA. More adequately powered and better-designed randomized controlled trials studies with long-term follow-up are required to produce evidence-based guidelines regarding the PTIP method.
Topics: Arthroplasty, Replacement, Knee; Blood Loss, Surgical; Ecchymosis; Humans; Pain, Postoperative; Randomized Controlled Trials as Topic; Range of Motion, Articular; Tourniquets
PubMed: 35212310
DOI: 10.1097/MD.0000000000028981 -
International Journal of Oral and... Aug 2020The aim of this systematic review was to compare the triangular and envelope flaps in mandibular third molar surgery with regard to pain, oedema, and trismus. Secondary... (Meta-Analysis)
Meta-Analysis
The aim of this systematic review was to compare the triangular and envelope flaps in mandibular third molar surgery with regard to pain, oedema, and trismus. Secondary outcomes assessed were dehiscence, ecchymosis, alveolar osteitis, periodontal condition, and surgical time. The PRISMA guidelines and recommendations in the Cochrane Handbook were followed, and the review was registered before commencement (PROSPERO; CRD42018112373). The literature search was conducted in the Web of Science, PubMed, Virtual Health Library, Cochrane Library, and Scopus databases and in the grey literature; randomized clinical trials, indexed through November 2018 were included. Three reviewers independently examined the studies. Twenty studies were included in the qualitative analysis, of which 18 were included in the meta-analyses. The flap design did not influence pain, oedema, trismus, dehiscence, or osteitis. The triangular flap was associated with a greater occurrence of postoperative ecchymosis (odds ratio 4.58, 95% confidence interval 1.34 to 15.91, I=0) and lower periodontal probing depth on day 7 postoperative (standardized mean difference -1.36, 95% confidence interval -2.68 to -0.03, I=88%) when compared to the envelope flap in mandibular third molar surgeries.
Topics: Humans; Mandible; Molar, Third; Pain, Postoperative; Tooth Extraction; Tooth, Impacted; Trismus
PubMed: 31974006
DOI: 10.1016/j.ijom.2020.01.001 -
Annals of Plastic Surgery Mar 2020Arnica and bromelain, two of the most widely recommended homeopathic medications to improve perioperative outcomes, have yet to be widely adopted by allopathic...
INTRODUCTION
Arnica and bromelain, two of the most widely recommended homeopathic medications to improve perioperative outcomes, have yet to be widely adopted by allopathic practitioners. A significant barrier to utilization of herbal medications by allopathic doctors is that the preparations and dosing regimens are not widely known or understood. The goal of this review was to critically analyze studies that have examined the perioperative efficacy of arnica and bromelain with a focus on treatment regimen and outcomes.
METHODS
A triple database search was conducted with the keywords "arnica," "bromelain," and "surgery." References for each identified article were analyzed for additional articles. Articles were analyzed for methodology, outcomes, and conclusion. Articles were excluded if they did not involve human subjects, were published before 1990, and if they were not available in English. Level of evidence was determined based on methodology.
RESULTS
A total of 29 articles met inclusion criteria, with 20 and 9 in the arnica and bromelain treatment groups, respectively. There was marked heterogeneity with regard to surgical procedure, dosing regimen, outcomes measured, and results. Arnica seems to have a mitigating effect on ecchymosis, most notably following rhinoplasty and facelifts/facial procedures. Bromelain is well supported across numerous studies in reducing trismus, pain, and swelling following molar extractions. However, there was no effect demonstrated when evaluating topical arnica following blepharoplasty procedures.
DISCUSSION
A systematic review of the literature demonstrates the potential for arnica and bromelain to improve perioperative outcomes including edema, ecchymosis, and pain control. Future studies are required to determine safety and efficacy of dosing and interactions with other medications. We hope this article stimulates surgeons to consider using these interventions to improve perioperative outcomes in the context of well-done studies with an objective analysis of results.
Topics: Arnica; Bromelains; Edema; Homeopathy; Humans; Plant Extracts; Postoperative Complications; Treatment Outcome
PubMed: 31800557
DOI: 10.1097/SAP.0000000000002043 -
Andrology Jan 2022Hyaluronic acid is a glycosaminoglycan widely used in the fields of orthopedics, ophthalmology, and aesthetic medicine due to its significant ability to reduce the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Hyaluronic acid is a glycosaminoglycan widely used in the fields of orthopedics, ophthalmology, and aesthetic medicine due to its significant ability to reduce the synthesis of pro-inflammatory proteins and its activity against oxidative stress, a feature of many degenerative illnesses.
OBJECTIVES
The objective of the present review is to provide a comprehensive narrative review of the most recent literature on the use of hyaluronic acid in andrology in order to facilitate the use of this therapeutic device in the common clinical practice of many physicians. Specific conditions covered in the review are Peyronie's disease, premature ejaculation, and penile enlargement.
MATERIALS AND METHODS
A broad and comprehensive literature search included Medline, EMBASE, and the Cochrane Libraries, with no time restriction up to December 2020 and restricted to English language publications. Unpublished studies were not included. The study was registered as "The role of hyaluronic acid in andrology: A systematic review and meta-analysis" in PROSPERO with the ID CRD42021223416.
DISCUSSION AND CONCLUSION
Hyaluronic acid is a valid choice for the treatment of Peyronie's disease in terms of the resolution of the acute phase of the disease and of contributing to stabilizing the disease as a bridge to potential surgery. Data, furthermore, suggest that hyaluronic acid is frequently associated with an overall clinical improvement, allowing the patient to resume normal sexual activity. With regard to premature ejaculation, data suggests hyaluronic acid-based treatments were effective in prolonging intra-vaginal ejaculation time. Furthermore, hyaluronic acid was found to be safe and well-tolerated, with main adverse events limited to local discomfort, ecchymosis, papule formation, and glans numbness, all of which were reported to resolve spontaneously. Last, with regard to penile enlargement, the overall perception of experts is that hyaluronic acid may be an extremely well-tolerated compound with potential for application in specific areas of male sexual health that are often neglected as compared to more common, and relatively simpler to treat, conditions.
Topics: Andrology; Humans; Hyaluronic Acid; Male; Penile Diseases; Penile Induration; Premature Ejaculation; Treatment Outcome
PubMed: 34297894
DOI: 10.1111/andr.13083 -
The Journal of Craniofacial Surgery Jan 2015The benefits of routine perioperative steroid use to decrease facial edema, ecchymosis, pain, and reduced length of hospitalization have been reported for many... (Review)
Review
BACKGROUND
The benefits of routine perioperative steroid use to decrease facial edema, ecchymosis, pain, and reduced length of hospitalization have been reported for many procedures. The role of perioperative steroids after open craniosynostosis surgery remains understudied. The purpose of our study was to assess the safety and efficacy of perioperative steroid administration in open repair of craniosynostosis based on current published clinical evidence.
METHODS
A systematic review of PubMed, EMBASE, ClinicalTrials.gov, and the Cochrane library databases using inclusion and exclusion criteria was performed for articles that studied the efficacy of perioperative steroid use in craniosynostosis patients receiving open cranial repair surgery.
RESULTS
Our review yielded 149 unique citations. One hundred thirty-nine titles were excluded based on predefined criteria. Ten abstracts and 4 articles (n = 14) qualified for full-text screening. Two additional relevant articles were identified using references. Three observational studies were eligible for data abstraction. A Cohen κ coefficient score of 0.88 demonstrated high interrater agreement throughout the screening process. Clinical benefits in this specific population observed were improved control of postoperative edema, earlier time to eye opening, and reduced length of hospital stay. The timing, method, and technique of steroid administration varied between studies.
CONCLUSIONS
The reviewed literature supports a clinical benefit following administration of perioperative steroids for open repair surgery of craniosynostosis. However, the current level of evidence on safety and efficacy remains limited in rigor and volume. Further randomized trials are necessary prior to recommending routine steroid use in our study population.
CLINICAL QUESTION/LEVEL OF EVIDENCE
therapeutic, level III.
Topics: Craniosynostoses; Ecchymosis; Edema; Glucocorticoids; Humans; Length of Stay; Perioperative Period
PubMed: 25569398
DOI: 10.1097/SCS.0000000000001405