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Research and Reports in Urology 2024Contact laser vaporization of the prostate (CVP) for benign prostatic hyperplasia is a widely accepted and safe procedure for elderly patients because of its lower...
PURPOSE
Contact laser vaporization of the prostate (CVP) for benign prostatic hyperplasia is a widely accepted and safe procedure for elderly patients because of its lower bleeding risks. However, CVP lacks a postoperative pathological examination for prostate cancer. Concomitant prostate biopsy and CVP may complement this disadvantage; however, the risk of bleeding associated with this procedure remains unclear. This study aimed to evaluate the safety of a concomitant prostate biopsy and CVP.
PATIENTS AND METHODS
This retrospective study included 106 men who had undergone CVP in Nerima General Hospital. Prostate biopsies and CVP were performed simultaneously on 16 patients. We defined the "hemorrhage group" by a >5% decrease in hemoglobin the day after surgery. Preoperative and operative indices were evaluated based on the association with the hemorrhage group.
RESULTS
Participants in the concomitant biopsy group were older ( = 0.001), had larger prostates ( = 0.014), a lower rate of prostate biopsy history ( = 0.046), longer postoperative urinary catheter duration ( = 0.024), and a higher rate of decline in hemoglobin levels the day after surgery ( = 0.023). Patients in the hemorrhage group ( = 20, 18.9%) showed a significantly higher rate of concomitant biopsy and CVP ( = 0.006). Multivariate analysis showed that concomitant prostate biopsy ( = 0.009, odds ratio = 4.61) was the sole statistically significant predictive factor for hemorrhage.
CONCLUSION
Concomitant prostate biopsy and CVP of the prostate may increase the risk of bleeding.
PubMed: 38855129
DOI: 10.2147/RRU.S457307 -
Research in Veterinary Science Aug 2024During tibial plateau leveling osteotomy (TPLO), the laceration of the cranial tibial artery (LCTA) may occur, and the ligation of the cranial tibial artery might lead...
During tibial plateau leveling osteotomy (TPLO), the laceration of the cranial tibial artery (LCTA) may occur, and the ligation of the cranial tibial artery might lead to impaired blood supply to the osteotomy site. The present case-control study aimed to evaluate the effect of LCTA on TPLO healing and the occurrence of perioperative complications. The incidence and predisposing factors to LCTA were also investigated. Fourteen cases experiencing LCTA were retrospectively enrolled from medical records of two veterinary teaching hospitals (LCTA group), whereas 28 randomly selected TPLOs that did not experience LCTA were included in the control group. Signalment data, proximal tibial epiphysis conformation, osteotomy features, perioperative complications, and bone healing were compared between the two groups. Bone healing was evaluated using the modified radiographic union scale for tibial fracture and the visual analog scale. The mean incidence was 9.6%. Bodyweight was significantly higher in the LCTA group compared to the control group (P = 0.009). Dogs belonging to the LCTA groups were significantly younger (P = 0.01). Intraoperative hypotension was significantly overreported in the LCTA group (P = 0.0001). None of the other variables differed significantly between the two groups. Dogs' size seems to be a predisposing factor, with dogs weighing >15 kg having 22 times more chance of experiencing LCTA. Due to the well-developed collateral blood supply of the canine hindlimb, LCTA and the closure of the cranial tibial artery did not appear to delay the radiographic bone healing or affect the incidence of perioperative complications.
Topics: Animals; Dogs; Osteotomy; Female; Male; Case-Control Studies; Retrospective Studies; Tibia; Tibial Arteries; Postoperative Complications; Dog Diseases; Fracture Healing; Lacerations
PubMed: 38851052
DOI: 10.1016/j.rvsc.2024.105322 -
Cureus May 2024Background Renal calculi therapy has advanced significantly in recent years, with mini-percutaneous nephrolithotomy (PCNL) emerging as a minimally invasive treatment...
Comparison of Swiss LithoClast Trilogy™ and Pneumatic Swiss LithoClast™ in Mini-Percutaneous Nephrolithotomy in Terms of Stone Free Rate and Complications: A Single-Center Experience From a Stone Belt Country.
Background Renal calculi therapy has advanced significantly in recent years, with mini-percutaneous nephrolithotomy (PCNL) emerging as a minimally invasive treatment modality. Mini-PCNL has been subjected to several modifications to achieve the best possible outcomes and reduce morbidity. This study aimed to compare the efficacy and safety of Swiss LithoClast Trilogy™ and pneumatic Swiss LithoClast™ in managing renal stones with mini-PCNL. Methodology This descriptive retrospective study was conducted at the Department of Urology, Lady Reading Hospital, from January 1, 2023, to December 31, 2023. A record of male and female patients aged more than 18 years who underwent mini-PCNL for renal stones was retrieved. The following two groups of patients were created: group A (n = 25) mini-PCNL with Swiss LithoClast Trilogy™ and group B (n = 26) mini-PCNL with pneumatic Swiss LithoClast™. The efficacy and safety profile of both groups was compared. Results A total of 51 patients were enrolled, with 25 in group A and 26 in group B. Groups A and B had mean ages of 45.2 and 47.5 years, respectively. Male participants outnumbered females in both groups, 72% (n = 18) in group A and 77% (n = 20) in group B. Group A had a mean stone size of 15.8 mm, and group B had a mean stone size of 16.5 mm. Stone-free rate on postoperative day one was 88% (n = 22) in group A and 84.6% (n = 22) in group B, with no statistically significant difference (p > 0.05). At the end of three months, 96% of participants in group A and 84.6% of patients in group B were found to be free of stones, and the difference between the two groups was not statistically significant (p > 0.05). Intraoperative hemorrhage occurred in 12% (n = 3) of group A and 15.4% (n = 4) of group B patients, with no significant difference (p > 0.05). Conclusions There were no significant differences in stone-free rates, complication rates, or intraoperative/postoperative complications between mini-PCNL with Swiss LithoClast Trilogy™ or Pneumatic Swiss LithoClast™.
PubMed: 38846212
DOI: 10.7759/cureus.59829 -
Brazilian Journal of Veterinary Medicine 2024Here, we describe the first case of a granular cell tumor (GCT) derived from the brachial nerve. Eleven-year-old neutered female Chihuahua presented to the hospital with...
Here, we describe the first case of a granular cell tumor (GCT) derived from the brachial nerve. Eleven-year-old neutered female Chihuahua presented to the hospital with a bulge from the left neck to the axilla. The dog had a spherical subcutaneous mass on the cervical subcutis, and cytology hinted at adenocarcinoma or neuroendocrine tumor. However, the origin of the tumor remains unknown. During resection of the mass, bleeding was difficult to control owing to the high blood flow, and tumor removal was extremely difficult. The caudal aspect of the mass was attached to the brachial nerve and had to be removed, along with parts of the nerve fibers. The patient's postoperative course was fair, but it developed paralysis of the left thoracic limb. Pathology revealed that the mass was positive for S100 and vimentin, and GCT was diagnosed. Non-oral GCTs are extremely rare. The clinical diagnosis of GCT is difficult and is often confirmed histopathologically by excision. Although most cases of GCT are benign, they must be recognized as hemorrhagic, indistinct masses that mimic malignancy. Excision carries the risk of hemorrhage and damage to the surrounding tissues to secure margins.
PubMed: 38840782
DOI: 10.29374/2527-2179.bjvm001424 -
Saudi Medical Journal Jun 2024To compare and measure post-operative outcomes among various surgical techniques for reducing inferior turbinate hypertrophy (ITH), and to identify the factors... (Comparative Study)
Comparative Study
OBJECTIVES
To compare and measure post-operative outcomes among various surgical techniques for reducing inferior turbinate hypertrophy (ITH), and to identify the factors associated with the clinical outcomes of turbinoplasty in patients with this condition.
METHODS
A cross-sectional study was carried out from January 2021 to December 2022 at the Otorhinolaryngology Department of King Abdulaziz Medical City in Riyadh, Saudi Arabia. A total of 301 adult patients with ITH were included and were divided into different groups. Postoperative follow-up assessments were completed after one week, one month, and 6 months to evaluate outcomes and complications associated with each surgical technique; descriptive analysis, cross-tabulation, and exact logistic regression were utilized as data analysis methods.
RESULTS
Most patients in both groups experienced partial or complete improvement after surgery, with 92% showing positive outcomes. Common clinical signs included deviated nasal septum deviation and external nasal deformity, while nasal obstruction was most frequently reported as the primary symptom. Post-surgery bleeding occurred in 3.7% of cases; no adhesions were noted. Microdebrider, medial flap, out-fracture, and submucosal diathermy techniques all demonstrated significantly higher improvement rates than others.
CONCLUSION
The identified techniques with higher improvement rates offer evidence-based guidance for selecting optimal surgical approaches, while the study's limitations warrant further prospective research to validate these findings. Ultimately, it contributes valuable knowledge to the field of otorhinolaryngology, aiming to enhance patient outcomes and improve the management of ITH worldwide.
Topics: Humans; Turbinates; Cross-Sectional Studies; Male; Female; Adult; Hypertrophy; Treatment Outcome; Nasal Obstruction; Middle Aged; Saudi Arabia; Postoperative Complications; Surgical Flaps; Nasal Septum; Young Adult; Postoperative Hemorrhage
PubMed: 38830656
DOI: 10.15537/smj.2024.45.6.20230977 -
World Journal of Gastrointestinal... May 2024Acute cholecystitis (AC) is a common disease in general surgery. Laparoscopic cholecystectomy (LC) is widely recognized as the "gold standard" surgical procedure for...
Evaluating effectiveness and safety of combined percutaneous transhepatic gallbladder drainage and laparoscopic cholecystectomy in acute cholecystitis patients: Meta-analysis.
BACKGROUND
Acute cholecystitis (AC) is a common disease in general surgery. Laparoscopic cholecystectomy (LC) is widely recognized as the "gold standard" surgical procedure for treating AC. For low-risk patients without complications, LC is the recommended treatment plan, but there is still controversy regarding the treatment strategy for moderate AC patients, which relies more on the surgeon's experience and the medical platform of the visiting unit. Percutaneous transhepatic gallbladder puncture drainage (PTGBD) can effectively alleviate gallbladder inflammation, reduce gallbladder wall edema and adhesion around the gallbladder, and create a "time window" for elective surgery.
AIM
To compare the clinical efficacy and safety of LC or PTGBD combined with LC for treating AC patients, providing a theoretical basis for choosing reasonable surgical methods for AC patients.
METHODS
In this study, we conducted a clinical investigation regarding the combined use of PTGBD tubes for the treatment of gastric cancer patients with AC. We performed searches in the following databases: PubMed, Web of Science, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Database. The search encompassed literature published from the inception of these databases to the present. Subsequently, relevant data were extracted, and a meta-analysis was conducted using RevMan 5.3 software.
RESULTS
A comprehensive analysis was conducted, encompassing 24 studies involving a total of 2564 patients. These patients were categorized into two groups: 1371 in the LC group and 1193 in the PTGBD + LC group. The outcomes of the meta-analysis revealed noteworthy disparities between the PTGBD + LC group and the LC group in multiple dimensions: (1) Operative time: Mean difference (MD) = 17.51, 95%CI: 9.53-25.49, < 0.01; (2) Conversion to open surgery rate: Odds ratio (OR) = 2.95, 95%CI: 1.90-4.58, < 0.01; (3) Intraoperative bleeding loss: MD = 32.27, 95%CI: 23.03-41.50, < 0.01; (4) Postoperative hospital stay: MD = 1.44, 95%CI: 0.14-2.73, = 0.03; (5) Overall postoperative complication rate: OR = 1.88, 95%CI: 1.45-2.43, < 0.01; (6) Bile duct injury: OR = 2.17, 95%CI: 1.30-3.64, = 0.003; (7) Intra-abdominal hemorrhage: OR = 2.45, 95%CI: 1.06-5.64, = 0.004; and (8) Wound infection: OR = 0. These findings consistently favored the PTGBD + LC group over the LC group. There were no significant differences in the total duration of hospitalization [MD = -1.85, 95%CI: -4.86-1.16, = 0.23] or bile leakage [OR = 1.33, 95%CI: 0.81-2.18, = 0.26] between the two groups.
CONCLUSION
The combination of PTGBD tubes with LC for AC treatment demonstrated superior clinical efficacy and enhanced safety, suggesting its broader application value in clinical practice.
PubMed: 38817274
DOI: 10.4240/wjgs.v16.i5.1407 -
Alternative Therapies in Health and... May 2024Right ventricular pacing (RVP) therapy is the conventional approach for atrioventricular block despite its propensity to cause electrical and mechanical dyssynchrony....
BACKGROUND
Right ventricular pacing (RVP) therapy is the conventional approach for atrioventricular block despite its propensity to cause electrical and mechanical dyssynchrony. This dyssynchrony increases the risk of atrial fibrillation and heart failure, eventually leading to left ventricular dysfunction. Left bundle branch pacing (LBBP) has recently emerged as a novel physiological pacing method. This study utilizes conventional ultrasound cardiography (UCG), two-dimensional speckle tracking imaging (2D-STI), and tissue Doppler imaging (TDI) to investigate the disparities in electrical and mechanical cardiac synchrony between LBBP and RVP patients.
METHODS
The retrospective analysis includes data from patients who underwent LBBP (n=50) and RVP (n=50) in Zhangjiagang First People's Hospital between January 2019 and June 2020, meeting the stipulated inclusion criteria. The study compares pacing parameters, UCG metrics, cardiac electrical and mechanical synchrony, pacing success rates, and safety events both pre-operation and at 3, 6, 12, and 24 months post-operation.
RESULTS
Implantation success rates for both RVP and LBBP groups were 100%, with 92% and 100% pacing success rates, respectively [P = .001 RR (95% CI) : 2.5 (1.5, 3.5)]. The LBBP group exhibited significant advantages over the RVP group throughout the follow-up period. LBBP patients displayed shortened QRS duration, reduced pacing thresholds and impedance, improved sensory function, lower serum NT-proBNP levels, and an increased proportion of NYHA class I patients [P = .003 RR (95% CI) : 1.6 (1.1, 2.3)]. Furthermore, left ventricular ejection fraction increased significantly, while left ventricular diastolic and end-systolic diameters decreased in the LBBP group compared to the RVP group [P = .004 RR (95% CI) : 1.7 (1.3, 2.2)]. The LBBP group also demonstrated shorter ventricular systolic synchrony parameters, including Tls-Dif, PSD, Trs-SD, Tas-SD, Tas-post, Ts-SD, and Ts-DIf, compared to the RVP group [P = .005 RR (95% CI) : 1.5 (1.2, 2.0)]. Notably, no postoperative complications occurred in either group, such as electrode displacement, lead thrombus attachment, incision bleeding, pocket hemorrhage, or infection. However, the readmission rates for heart failure were 16% in the RVP group and 2% in the LBBP group.
CONCLUSION
LBBP achieves physiological cardiac pacing, leading to significant improvements in serum NT-proBNP levels and cardiac function and enhanced ventricular contraction synchrony. Utilizing UCG, 2D-STI, and TDI for quantitative evaluation of cardiac electrical and mechanical synchrony proves to be a valuable clinical approach.
PubMed: 38814612
DOI: No ID Found -
World Journal of Gastroenterology May 2024Hemorrhoidal artery embolization (Emborrhoid) is a novel method for the treatment of severe hemorrhoidal bleeding. Despite having a technical success rate of 93%-100%,... (Observational Study)
Observational Study
BACKGROUND
Hemorrhoidal artery embolization (Emborrhoid) is a novel method for the treatment of severe hemorrhoidal bleeding. Despite having a technical success rate of 93%-100%, the clinical success ranges between 63% and 94%, with a rebleeding rate of 13.6%.
AIM
To evaluate the effectiveness of this procedure in reducing hemorrhoidal flow and hemorrhoidal bleeding.
METHODS
This prospective observational pilot study was conducted at Division of General Surgery 1 and Tertiary Referral Pelvic Floor Center, Treviso Regional Hospital, Italy. In a 2 months period (February-March 2022), consecutive patients with hemorrhoidal bleeding scores (HBSs) ≥ 4, Goligher scores of II or III, failure of non-operative management, and a candidate for Emborrhoid were included. Endoanal ultrasound with eco-Doppler was performed preoperatively and 1 month after the procedure. The primary endpoint was to quantify the changes in arterial hemorrhoidal flow after treatment. The secondary endpoint was to evaluate the correlation between the flow changes and the HBS.
RESULTS
Eleven patients underwent Emborrhoid. The overall pretreatment mean systolic peak (MSP) was 14.66 cm/s. The highest MSP values were found in the anterior left lateral (17.82 cm/s at 1 o'clock and 15.88 cm/s at 3 o'clock) and in the posterior right lateral (14.62 cm/s at 7 o'clock and 16.71 cm/s at 9 o'clock) quadrants of the anal canal. After treatment, the overall MSP values were significantly reduced ( = 0.008) although the correlation between MSP and HBS changes was weak ( = 0.570). A statistical difference was found between distal embolization compared with proximal embolization ( = 0.047). However, the coil landing zone was not related to symptoms improvement ( = 1.000). A significant difference in MSP changes was also reported between patients with type 1 and type 2 superior rectal artery (SRA) anatomy ( = 0.040). No relationship between hemorrhoidal grades ( = 1.000), SRA anatomy ( = 1.000) and treatment outcomes was found.
CONCLUSION
The preliminary findings of this pilot study confirm that Emborrhoid was effective in reducing the arterial hemorrhoidal flow in hemorrhoidal disease. However, the correlation between the post-operative MSP and HBS changes was weak. Hemorrhoidal grade, SRA anatomy and type of embolization were not related to treatment outcomes.
Topics: Humans; Embolization, Therapeutic; Hemorrhoids; Pilot Projects; Female; Male; Prospective Studies; Middle Aged; Treatment Outcome; Adult; Aged; Ultrasonography, Doppler; Anal Canal; Arteries; Endosonography; Gastrointestinal Hemorrhage; Recurrence
PubMed: 38813050
DOI: 10.3748/wjg.v30.i17.2332 -
Turkish Journal of Medical Sciences 2023Chronic subdural hematoma is the most frequently operated on intracranial hemorrhage worldwide. Although surgical results are satisfactory, recurrence remains an... (Comparative Study)
Comparative Study
BACKGROUND/AIM
Chronic subdural hematoma is the most frequently operated on intracranial hemorrhage worldwide. Although surgical results are satisfactory, recurrence remains an important problem. In this study, it was aimed to evaluate patients who underwent craniotomy with limited membranectomy (CwLM) in terms of recurrence rate and other complications.
MATERIALS AND METHODS
Electronic records of 291 consecutive patients who were operated on at our clinic (Atatürk University Yakutiye Research Hospital) between 2015 and 2020 were retrospectively reviewed. Their radiological images at the time of admission, clinical status, any early postoperative complications, and clinical status at the 6-month follow-up were all evaluated.
RESULTS
According to the results of the study, postoperative mortality and morbidity of patients who underwent CwLM were similar to those with minimally invasive methods, and it reduced recurrence, especially in laminar and separated subtypes.
CONCLUSION
It is our belief that CwLM will be an appropriate treatment approach in suitable patients (radiologically detected) in chronic subdural hematoma, where recurrence is an important problem.
Topics: Humans; Hematoma, Subdural, Chronic; Craniotomy; Male; Female; Retrospective Studies; Middle Aged; Aged; Adult; Treatment Outcome; Postoperative Complications; Recurrence; Aged, 80 and over
PubMed: 38813030
DOI: 10.55730/1300-0144.5699