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Shock (Augusta, Ga.) May 2024Introduction: Accurate and real-time monitoring of surgical blood loss is essential for ensuring intraoperative safety. However, there is currently no standard way to...
Introduction: Accurate and real-time monitoring of surgical blood loss is essential for ensuring intraoperative safety. However, there is currently no standard way to assess the amount of blood lost in patients during surgery. This study aims to evaluate the accuracy and precision of a new automatic intraoperative blood loss monitor, which can measure both free blood volume and blood content in sponges in real time. Methods: The monitor uses an integrated photoelectric probe to gauge hemoglobin levels in both free blood and blood taken from surgical sponges. These data, combined with initial hemoglobin levels, are processed using specific calculations to determine blood volume. We created 127 diverse free blood samples and 160 blood-containing sponge samples by using fresh pig blood and physiological saline. The monitor then measured these samples. We subsequently compared its measurements with actual values acquired through physical measurements, detecting both agreement and measurement errors. Repeated measurements were performed to calculate the coefficient of variation, thereby evaluating the monitor's precision. Results: The estimated blood loss percentage error of the monitor was 5.2% for free blood, -5.7% for small sponge, -6.3% for medium sponge, and -6.6% for large sponge. The coefficient of variation of free blood with different hemoglobin concentrations measured by the monitor was less than 10%. Bland-Altman analysis showed that the limits of agreement between the monitor and the reference method were all within the acceptable clinical range. Conclusion: The new automatic intraoperative blood loss monitor is an accurate and reliable device for monitoring both free blood and surgical sponge blood, and shows high performance under various clinical simulation conditions.
Topics: Animals; Swine; Blood Loss, Surgical; Monitoring, Intraoperative; Hemoglobins; Humans; Surgical Sponges; Blood Volume
PubMed: 38010043
DOI: 10.1097/SHK.0000000000002251 -
International Journal of Surgery Case... Dec 2023Positioning nodule with a steel wire in pulmonary surgery is a common preoperative step. To date, no reports have been published on the retention of steel wires in the...
INTRODUCTION AND IMPORTANCE
Positioning nodule with a steel wire in pulmonary surgery is a common preoperative step. To date, no reports have been published on the retention of steel wires in the body post-surgery, nor have there been studies describing the ultrasound-guided removal of foreign objects from the chest wall. This report describes a case of a foreign matter was removed from the chest wall by ultrasound-guided.
CASE PRESENTATION
A 70-year-old woman underwent thoracoscope resection of a pulmonary nodule; however, a fragment of the positioning steel wire remained in the chest wall during the surgery. The anesthetist located the residual steel wire using ultrasound, and subsequently, the surgeon successfully removed it.
CLINICAL DISCUSSION
Detection of foreign matter in the body is rare and usually associated with trauma or accidental retention of materials such as absorbable gelatin sponges or sutures during surgery, which are often found using X-rays. This process is often time-consuming, and X-rays being radioactive are potentially harmful to patients and medical workers. Ultrasonic waves are safe and offer a convenient alternative for such procedures. We removed the residual steel wire through a 0.5 cm skin incision, this method neither caused trauma nor increased costs.
CONCLUSION
Ultrasonography-assisted positioning is a rapid, convenient, and safe technique, promising to enhance future surgical interventions.
PubMed: 38006738
DOI: 10.1016/j.ijscr.2023.109091 -
International Journal of Molecular... Nov 2023Uncontrollable bleeding continues to stand as the primary cause of fatalities globally following surgical procedures, traumatic incidents, disasters, and combat...
Uncontrollable bleeding continues to stand as the primary cause of fatalities globally following surgical procedures, traumatic incidents, disasters, and combat scenarios. The swift and efficient management of bleeding through the application of hemostatic agents has the potential to significantly reduce associated mortality rates. One significant drawback of currently available hemostatic products is their susceptibility to bacterial infections at the bleeding site. As this is a prevalent issue that can potentially delay or compromise the healing process, there is an urgent demand for hemostatic agents with antibacterial properties to enhance survival rates. To mitigate the risk of infection at the site of a lesion, we propose an alternative solution in the form of a chitosan-based sponge and antimicrobial agents such as silver nanoparticles (AgNPs) and lavender essential oil (LEO). The aim of this work is to provide a new type of hemostatic sponge with an antibacterial barrier against a wide range of Gram-positive and Gram-negative microorganisms: 2018 and VRE 2566 (Gram-positive strains) and ATCC 10031 and ATCC 35218 (Gram-negative strains).
Topics: Chitosan; Hemostatics; Metal Nanoparticles; Silver; Anti-Bacterial Agents; Microbial Sensitivity Tests
PubMed: 38003499
DOI: 10.3390/ijms242216312 -
Gastrointestinal Endoscopy Jun 2024
Topics: Humans; Esophageal Perforation; Echocardiography, Transesophageal; Surgical Sponges; Male; Negative-Pressure Wound Therapy; Middle Aged
PubMed: 37995764
DOI: 10.1016/j.gie.2023.11.031 -
Infection, Disease & Health Feb 2024Adequate hand hygiene is considered as one of the most effective strategies in healthcare-related infection prevention. The potential negative effect of rings in hand... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Adequate hand hygiene is considered as one of the most effective strategies in healthcare-related infection prevention. The potential negative effect of rings in hand disinfection and thus, in increased nosocomial infections rates is still controversial. Therefore, the present study was designed with the purpose of examining if rings frequently exposed to surgical scrubbing were associated or not with increased bacterial counts.
METHODS
32 volunteers were randomized into 4 groups: A (no rings), B (participants wore a ring), C (no rings and performed surgical scrubbing with chlorhexidine every 48 h) and D (participants wore a ring and performed surgical scrubbing every 48 h). Glove juice samples were obtained at day 0 (T0) and after a 90-min mock-surgery on day 14 (T1). Quantitative (number of UFC/mL) and qualitative data (microorganism type) were collected as study variables.
RESULTS
All groups were comparable at T0. All ring carriers obtained negative cultures at T1. Ring presence was not associated with higher bacterial counts; comparisons between A vs B groups and C vs D groups showed no statistically significant differences (p = 0.076 and 1.000). T1 negative cultures were more frequent in participants performing surgical scrubbing every second day (93.8 % vs 75 %), although this difference did not reach statistical significance (p = 0.332).
CONCLUSIONS
The presence of single plain ring does not seem to be associated with an increased hand bacterial load. Regular surgical scrubbing with chlorhexidine impregnated sponges reduces bacterial contamination of hands, even in the presence of plain rings.
Topics: Humans; Chlorhexidine; Bacterial Load; Hand; Bacteria; Health Personnel
PubMed: 37993309
DOI: 10.1016/j.idh.2023.10.003 -
International Journal of Surgery Case... Dec 2023Gossypiboma is a term used to describe a condition of leaving a surgical sponge or any other foreign object in a body cavity after surgery. Gossypiboma is a rare but...
INTRODUCTION
Gossypiboma is a term used to describe a condition of leaving a surgical sponge or any other foreign object in a body cavity after surgery. Gossypiboma is a rare but serious medical and legal problem, as it may cause no symptoms or severe complications in the digestive system. In some cases, Gossypiboma may migrate through the wall of an organ and cause damage, such as perforation, obstruction, or fistula formation.
CASE REPORT
A 46-year-old male presented to the Emergency Department with abdominal pain, diarrhea, vomiting, and weight loss of about 15 kg through 20 days. The condition developed into constipation.
DISCUSSION
The prevalence of complications, known as Gossypibomas, is relatively rare but can cause inflammatory reactions, abscesses, and other complications. Diagnosis is challenging and may require thorough evaluation, imaging, and exploratory surgery. Treatment usually involves surgical removal, either through laparoscopy or laparotomy. Prevention methods, such as accurate counting and implementing surgical safety protocols, are crucial to avoid such incidents.
CONCLUSION
Performing a thorough count of all surgical sponges and instruments at both the start and conclusion of the procedure is the most effective method to prevent Gossypiboma. Other preventive measures include using radiopaque sponges and making sure that all sponges are accounted for before closing the incision.
PubMed: 37992669
DOI: 10.1016/j.ijscr.2023.109067 -
Annals of Surgical Oncology Mar 2024Establishment of inflow control and gentle effective retraction of the liver for optimal exposure are critical to safe hepatectomy. Multiple methods have been previously...
Establishment of inflow control and gentle effective retraction of the liver for optimal exposure are critical to safe hepatectomy. Multiple methods have been previously reported for inflow control in minimally invasive (MIS) hepatectomy including Huang's Loop. We describe here the assembly and use of our modified version of Huang's loop that permits adjustable, atraumatic, and totally intracorporeal inflow control. We use a soft 16-French urinary catheter with a single premade opening near the blunt tip, across which a small slit is created. A beveled cut is made to the catheter 12-15 cm from the blunt tip and a suture sewn there that can be grasped to pull this beveled tail through the slit and window around the porta hepatis; this loop can be tightened or loosened with ease. For liver retraction, current techniques can be traumatic, especially when instruments apply traction directly onto the liver. Our preferred approach utilizes a liver sling made from a soft, rolled surgical sponge with 15-cm silk ties secured at each end; the length of the sling can be adjusted on the basis of thickness of the liver. The sling applies gentle, atraumatic "pulling" traction and is especially useful for exposure of the right posterior sector. We also use external band retraction to align the transection plane with the camera. Both also provide countertraction when advancing instruments into a firm or fibrotic liver. These techniques are commonly used in our MIS practice, and we have found them to be cost-efficient, easily reproducible, and effective.
Topics: Humans; Hepatectomy; Robotic Surgical Procedures; Liver Neoplasms; Liver Cirrhosis; Laparoscopy; Blood Loss, Surgical
PubMed: 37989954
DOI: 10.1245/s10434-023-14593-y -
International Journal of Surgery Case... Dec 2023Retained gauze sponge is a medical legal issue with significant clinical implications with catastrophic complications. We report a case of a female who presented with...
INTRODUCTION AND IMPORTANCE
Retained gauze sponge is a medical legal issue with significant clinical implications with catastrophic complications. We report a case of a female who presented with chronic right iliac fossa pain only to be found to have a retained gauze sponge causing bowel fistulisation. We describe our experience on diagnostic formulation and work up and subsequent operative intervention.
CASE PRESENTATION
We present the case of a 37-year-old female patient who presented to the outpatient surgical department with symptoms of chronic right iliac fossa pain with a history of cesarean section 2 years prior. A computed tomography scan revealed an inflammatory mass and operative exploration revealed a retained gauze sponge causing a fistula between the terminal ileum and caecum. Underwent a right hemicolectomy with an uneventful postoperative period.
CLINICAL DISCUSSION
Retained gauzes can lead to a spectrum of complications including fistulisation presenting with vague non-specific abdominal symptoms. The subtle presentation challenges the clinician to consider the possibility of retained foreign bodies in patient with history of abdominal surgeries. This emphasizes the importance of policies enforcing swab count as a simple retained gauze led to catastrophic complication and ultimately a right hemicolectomy.
CONCLUSION
This case report presents a complex and instructive clinical scenario, emphasizing the challenges of diagnosing atypical presentations of retained foreign bodies, the critical importance of surgical counting protocols, and the implications for patient safety and quality of care.
PubMed: 37988983
DOI: 10.1016/j.ijscr.2023.109081 -
Eye (London, England) Apr 2024To compare the safety and efficacy of subconjunctival injection of Mitomycin C(MMC) with sponge-applied MMC during trabeculectomy. (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
To compare the safety and efficacy of subconjunctival injection of Mitomycin C(MMC) with sponge-applied MMC during trabeculectomy.
METHODS
This prospective, randomised, interventional study was conducted on consecutive patients with uncontrolled glaucoma. 137 patients were randomised into an Injection group (Group 1, n = 66) and a sponge group (Group 2, n = 71). Trabeculectomy was performed in all patients who were followed up on days 1, 15, 30, 3 months, 6 months, 1 year, 2 years & 3 years postoperatively. Baseline & follow-up visits were compared to find out difference in the number of antiglaucoma medications (AGM), Intraocular pressure (IOP), and Best Corrected Visual Acuity (BCVA). In Group 1, the surgeon used MMC 0.2 mg/ml as subconjunctival injection and two separate semicircular surgical sponges soaked with MMC solution of 0.2 mg/mL were inserted subconjunctivally in Group 2.
RESULTS
Mean preop IOP was 34.21 ± 13.3 mmHg & 34.17 ± 10.6 mmHg in group 1 & 2 respectively, which reduced to 11.34 ± 3.7& 12.57 ± 4.7 mmHg(6 months),11.97 ± 4.2 & 13.60 ± 5.3 mmHg(1 year),12.42 ± 4.4 & 11.77 ± 2.8 mmHg (2 years) &11.25 ± 3.2 & 11.81 ± 3.2 mmHg at final visit(P < 0.001 in both groups)with no significant difference between the groups. The mean number of preoperative AGM was 2.32 ± 0.7 & 2.32 ± 0.8 in group1 & 2 respectively which reduced to 0.78 ± 0.9 (P < 0.001) & 1.13 ± 1.1(P = 0.930) at 3 years. Overall success rates were 75.3% in group 1 and 70.7% in group 2 at 3 years(p = 0.512). Postoperative complications and the final post-operative visual outcomes were similar between the groups.
CONCLUSION
Subconjunctival Injection of MMC is as safe and effective as sponge application with comparable surgical outcomes and complications in the long term.
Topics: Humans; Mitomycin; Trabeculectomy; Prospective Studies; Glaucoma, Open-Angle; Treatment Outcome; Follow-Up Studies; Intraocular Pressure
PubMed: 37968512
DOI: 10.1038/s41433-023-02816-1 -
Polymers Nov 2023It is known that complexes based on natural polysaccharides are able to eliminate bone defects. Prolonged hyperglycemia leads to low bone regeneration and a chronic...
It is known that complexes based on natural polysaccharides are able to eliminate bone defects. Prolonged hyperglycemia leads to low bone regeneration and a chronic inflammatory response. The purpose of this study was to increase the efficiency of early bone formation in a cavity of critical size in diabetes mellitus in the experiment. The polyelectrolyte complex contains high-molecular ascorbate of chitosan, chondroitin sulfate, sodium hyaluronate, heparin, adgelon serum growth factor, sodium alginate and amorphous nanohydroxyapatite (CH-SA-HA). Studies were conducted on five groups of white female Wistar rats: group 1-regeneration of a bone defect in healthy animals under a blood clot; group 2-regeneration of a bone defect under a blood clot in animals with diabetes mellitus; group 3-bone regeneration in animals with diabetes mellitus after filling the bone cavity with a collagen sponge; group 4-filling of a bone defect with a CH-SA-HA construct in healthy animals; group 5-filling of a bone defect with a CH-SA-HA construct in animals with diabetes mellitus. Implantation of the CH-SA-HA construct into bone cavities in type I diabetic rats can accelerate the rate of bone tissue repair. The inclusion of modifying polysaccharides and apatite agents in the construction may be a prospect for further improvement of the properties of implants.
PubMed: 37960017
DOI: 10.3390/polym15214337