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Transfusion Medicine and Hemotherapy :... Jun 2024Autologous blood transfusion techniques are well applied in surgery, but the red blood cells (RBCs) collected during laparoscopic surgery may forfeit their ability to...
Ozone Improves Oxygenation and Offers Organ Protection after Autologous Blood Transfusion in a Simulated Carbon Dioxide Pneumoperitoneal Environment in a Rabbit Hemorrhagic Shock Model.
OBJECTIVES
Autologous blood transfusion techniques are well applied in surgery, but the red blood cells (RBCs) collected during laparoscopic surgery may forfeit their ability to oxygenate. O is a potent oxidation gas. This study investigates whether O could improve the oxygen-carrying capacity of RBCs, reduce inflammatory reactions, and offer organ protection.
METHODS
We established a hemorrhagic shock model in rabbits, and simulated CO pneumoperitoneum and O were applied before autologous blood transfusion. Perioperative mean arterial pressure and arterial blood gas were recorded, blood gas and RBC morphology of collected blood were analyzed, plasma IL-6, ALT, AST, CRE, and lung histopathology POD0 and POD3 were tested, as well as postoperative survival quality.
RESULTS
Autologous blood that underwent simulated CO pneumoperitoneum had a lower pH and SaO and a higher PaCO than the control group. After O treatment, PaO and SaO increased significantly, with unchanged pH values and PaCO. RBCs in autologous blood were drastically deformed after CO conditioning and then reversed to normal by O treatment. Rabbits that received CO-conditioned autologous blood had a compromised survival quality after surgery, higher plasma IL-6 levels, higher lung injury scores on POD0, higher ALT and AST levels on POD3, and O treatment alleviated these adverse outcomes.
CONCLUSION
O can restore RBC function, significantly improve blood oxygenation under simulated CO pneumoperitoneum, offer organ protection, and improve the postoperative survival quality in the rabbit hemorrhage shock model.
PubMed: 38867809
DOI: 10.1159/000527934 -
Journal of the Formosan Medical... Jun 2024Spontaneous intracerebral hemorrhage (ICH) accounts for up to 20% of all strokes and results in 40% mortality at 30 days. Although conservative medical management is...
BACKGROUND
Spontaneous intracerebral hemorrhage (ICH) accounts for up to 20% of all strokes and results in 40% mortality at 30 days. Although conservative medical management is still the standard treatment for ICH patients with small hematoma, patients with residual hematoma ≤15 mL after surgery are associated with better functional outcomes and survival rates. This study reported our clinical experience with using Robotic Stereotactic Assistance (ROSA) as a safe and effective approach for stereotactic ICH aspiration and intra-clot catheter placement.
METHODS
A retrospective analysis was conducted of patients with spontaneous ICH who underwent ROSA-guided ICH aspiration surgery. ROSA-guided ICH surgical techniques, an aspiration and intra-clot catheter placement protocol, and a specific operative workflow (pre-operative protocol, intraoperative procedure and postoperative management) were employed to aspirate ICH using the ROSA One Brain, and appropriate follow-up care was provided.
RESULTS
From September 14, 2021 to May 4, 2022, a total of 7 patients were included in the study. Based on our workflow design, ROSA-guided stereotactic ICH aspiration effectively aspirated more than 50% of hematoma volume (or more than 30 mL for massive hematomas), thereby reducing the residual hematoma to less than 15 mL. The mean operative time of entire surgical procedure was 1.3 ± 0.3 h, with very little perioperative blood loss and no perioperative complications. No patients required catheter replacement and all patients' functional status improved.
CONCLUSIONS
Within our clinical practice ROSA-guided ICH aspiration, using our established protocol and workflow, was safe and effective for reducing hematoma volume, with positive functional outcomes.
PubMed: 38866694
DOI: 10.1016/j.jfma.2024.05.018 -
JMIR Research Protocols Jun 2024With the continuous advancement of cancer treatments, a comprehensive analysis of the impact of multivisceral oncological pancreatic resections on morbidity, mortality,...
BACKGROUND
With the continuous advancement of cancer treatments, a comprehensive analysis of the impact of multivisceral oncological pancreatic resections on morbidity, mortality, and long-term survival is currently lacking.
OBJECTIVE
This manuscript presents the protocol for a systematic review and meta-analysis designed to summarize the existing evidence concerning the outcomes of multivisceral oncological pancreatic resections across diverse tumor entities.
METHODS
We will conduct a systematic search of the PubMed or MEDLINE, Embase, Cochrane Library, CINAHL, and ClinicalTrials.gov databases in strict accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The predefined outcomes encompass postoperative mortality, postoperative morbidity, overall and disease-free survival (1- to 5-year survival rates), the proportion of macroscopically complete (R0) resections (according to the Royal College of Pathologists definition), duration of hospital stay (in days), reoperation rate (%), postoperative complications (covering all complications according to the Clavien-Dindo classification), as well as pancreatic fistula, postpancreatectomy hemorrhage, and delayed gastric emptying (all according to the definitions of the International Study Group of Pancreas Surgery).
RESULTS
Systematic database searches will begin in July 2024. The completion of the meta-analysis is anticipated by December 2024. Before completion, the literature search will be checked for new publications that must be considered in the context of the work.
CONCLUSIONS
The forthcoming findings will provide an up-to-date overview of the feasibility, safety, and oncological efficacy of multivisceral pancreatic resections across diverse tumor entities. This data will serve as a valuable resource for health care professionals and patients to make well-informed clinical decisions.
TRIAL REGISTRATION
PROSPERO CRD42023437858; https://tinyurl.com/bde5xmfw.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
PRR1-10.2196/54089.
Topics: Humans; Systematic Reviews as Topic; Pancreatic Neoplasms; Meta-Analysis as Topic; Pancreatectomy; Postoperative Complications
PubMed: 38861712
DOI: 10.2196/54089 -
Frontiers in Medicine 2024Exploring factors associated with the outcome of patients with aneurysmal subarachnoid hemorrhage (aSAH) has become a hot focus in research. We sought to investigate the...
Red blood cell count in cerebrospinal fluid was correlated with inflammatory markers on the seventh postoperative day and all associated with the outcome of aneurysmal subarachnoid hemorrhage patients.
BACKGROUND
Exploring factors associated with the outcome of patients with aneurysmal subarachnoid hemorrhage (aSAH) has become a hot focus in research. We sought to investigate the associations of inflammatory markers and blood cell count in cerebrospinal fluid with the outcome of aSAH patients.
METHODS
We carried a retrospective study including 200 patients with aSAH and surgeries. The associations of neutrophil, lymphocyte, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), systemic immune inflammation index (SII), system inflammation response index (SIRI), and blood cell count in cerebrospinal fluid on the 1st and 7th postoperative days with the outcome of aSAH patients were investigated by univariate analysis and multivariate logistic regression model.
RESULTS
According to the modified Rankin scale (mRS) score, there were 147 patients with good outcome and 53 patients with poor outcome. The neutrophil, NLR, SIRI, and SII levels on the seventh postoperative day in patients with poor outcome were all significantly higher than patients with good outcome, < 0.05. The multivariate logistic regression model including inflammatory markers and blood cell counts in cerebrospinal fluid on the 1st postoperative day confirmed that red blood cell count in cerebrospinal fluid (≥177 × 10/L; OR: 7.227, 95% CI: 1.160-45.050, = 0.034) was possibly associated with poor outcome of aSAH patients, surgical duration (≥169 min), Fisher grade (III-IV), hypertension, and infections were also possibly associated with the poor outcome. The model including inflammatory markers and blood cell counts in cerebrospinal fluid on the 7th postoperative day confirmed that red blood cell count in cerebrospinal fluid (≥54 × 10/L; OR: 39.787, 95% CI: 6.799-232.836, < 0.001) and neutrophil-lymphocyte ratio (≥8.16; OR: 6.362, 95% CI: 1.424-28.428, = 0.015) were all possibly associated with poor outcome of aSAH patients. The NLR ( = 0.297, = 0.007) and SIRI ( = 0.325, = 0.003) levels were all correlated with the count of red blood cells in cerebrospinal fluid.
DISCUSSION
Higher neutrophil-lymphocyte ratio and higher red blood cell count in cerebrospinal fluid were all possibly associated with poor outcome of patients with aneurysmal subarachnoid hemorrhage. However, we need a larger sample study.
PubMed: 38860207
DOI: 10.3389/fmed.2024.1408126 -
World Neurosurgery Jun 2024A retrospective study of cases of endovascular treatment of dissection of the vertebral artery with subarachnoid hemorrhage was conducted.
INTRODUCTION
A retrospective study of cases of endovascular treatment of dissection of the vertebral artery with subarachnoid hemorrhage was conducted.
MATERIAL AND METHODS
Data were 11 cases of vertebral artery dissecting aneurysm (VADA)s among 291 consecutive SAH patients who underwent clipping or endovascular treatment at Ota Memorial Hospital. Classified into four patterns based on the location of the dissection and posterior inferior cerebellar artery (PICA): Pre-PICA, post-PICA, involved PICA, and non-PICA. And one of the case had bilateral vertebral artery dissection, and Computational fluid dynamics (CFD) analysis was included in the study.
RESULTS
Ruptured VADA occurred in 11 of the 291 patients (3.8%). Endovascular treatment was performed in 8 of these 11 patients. Postoperative diffusion-weighted imaging (DWI) detected no high intensity lesions and no postoperative ischemic complications or rebleeding occurred in any patient. In a case of bilateral VADA, computational fluid dynamics (CFD) analysis very low or high wall shear stress (WSS) at the dissection, low aneurysm formation indicator (AFI), and high oscillatory shear index(OSI) may be considered rupture factors.
CONCLUSION
Treatment strategies for each branching pattern of PICA can prevent rupture and avoid ischemic complications. And prediction of the rupture side is important in patients with bilateral dissection to consider the appropriate treatment and timing.
PubMed: 38857867
DOI: 10.1016/j.wneu.2024.06.007 -
Journal of Neurosurgery. Case Lessons Jun 2024Essential tremor (ET) is one of the most common movement disorders worldwide. In medically refractory ET, deep brain stimulation (DBS) of the ventral intermediate...
Magnetic resonance imaging-guided focused ultrasound thalamotomy for essential tremor in a patient with von Willebrand disease: perioperative optimization for patients with coagulopathies. Illustrative case.
BACKGROUND
Essential tremor (ET) is one of the most common movement disorders worldwide. In medically refractory ET, deep brain stimulation (DBS) of the ventral intermediate nucleus of the thalamus is the current standard of care. However, DBS carries an inherent 2% to 3% risk of hemorrhage, a risk that can be much higher in patients with concomitant coagulopathy. Magnetic resonance imaging-guided focused ultrasound (MRgFUS) thalamotomy is a surgical alternative that is highly effective in treating ET, with no reports of intracranial hemorrhage to date.
OBSERVATIONS
This is the first documented case of successful MRgFUS thalamotomy in a patient with von Willebrand disease (VWD). A 60-year-old left-handed male had medically refractory ET, VWD type 2B, and a family history of clinically significant hemorrhage after DBS. He underwent right-sided MRgFUS thalamotomy and received a perioperative course of VONVENDI (recombinant von Willebrand factor) to ensure appropriate hemostasis. Postprocedure imaging confirmed a focal lesion in the right thalamus without evidence of hemorrhage. The patient reported 90% improvement of his left-hand tremor and significant improvement in his quality of life without obvious side effects.
LESSONS
MRgFUS thalamotomy with peri- and postoperative hematological management is a promising alternative to DBS for patients with underlying coagulopathies.
PubMed: 38857545
DOI: 10.3171/CASE23766 -
European Review For Medical and... May 2024Free tissue transfer has an established place in oncologic head and neck surgery. However, the necessity and specific regimen of perioperative thromboprophylaxis remain... (Comparative Study)
Comparative Study
OBJECTIVE
Free tissue transfer has an established place in oncologic head and neck surgery. However, the necessity and specific regimen of perioperative thromboprophylaxis remain controversial. Here, the risk of postoperative hemorrhage contrasts with vascular pedicle thrombosis and graft loss. This work compares three different heparin protocols (A-C) with regard to postoperative complications.
PATIENTS AND METHODS
A retrospective analysis of our free flap transplants between 2004 and 2023 was conducted. Inclusion criteria were thromboprophylaxis with (A) 500 IU/h unfractionated heparin (UFH), (B) low-molecular-weight heparin (LMWH) once daily, and (C) LMWH once daily with additional immediate preoperative administration. Primary endpoints were the incidence of postoperative bleeding and hematoma and the appearance of flap thrombosis.
RESULTS
We evaluated 355 cases, 87 in group A, 179 in group B, and in group C 89 patients. Overall, postoperative bleeding occurred in 8.7% of patients, and 83% underwent hemostasis under intubation anesthesia, with no significant difference between groups (p = 0.784). Hematoma formation requiring revision was found in 3.7% of patients (p = 0.660). We identified postoperative hematoma as a significant influencing factor for venous pedicle thrombosis (OR 3.602; p = 0.001). Venous and arterial flap thrombosis in the graft vessel showed no difference between the groups (p = 0.745 and p = 0.128).
CONCLUSIONS
The three anticoagulation regimens appear to be equivalent therapy for the prevention of thrombosis without significant differences in postoperative bleeding. The use of LMWH with additional preoperative administration can, therefore, be administered in free flap reconstruction.
Topics: Humans; Anticoagulants; Free Tissue Flaps; Retrospective Studies; Middle Aged; Female; Male; Plastic Surgery Procedures; Heparin, Low-Molecular-Weight; Aged; Thrombosis; Postoperative Hemorrhage; Heparin; Adult; Head and Neck Neoplasms; Perioperative Care; Postoperative Complications
PubMed: 38856128
DOI: 10.26355/eurrev_202405_36288 -
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