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Visceral Medicine Mar 2023An acquired esophago-respiratory fistula represents an abnormal connection between the esophagus and the respiratory system. It is usually caused by malignancy and...
An acquired esophago-respiratory fistula represents an abnormal connection between the esophagus and the respiratory system. It is usually caused by malignancy and infection, or it occurs as a complication after surgery or radiation therapy. It can be divided according to its anatomical level into esophago-tracheal fistula, esophago-bronchial fistula, and in the rarest case, esophago-pulmonary fistula (EPF). We present a case of EPF aggravating an anastomotic leak (AL) after the Ivor-Lewis operation for esophageal cancer. The leak was treated with endoscopic vacuum therapy (EVT) using the Eso-Sponge® system (B. Braun Melsungen AG, Melsungen, Germany). In the further course of treatment, an EPF was suspected by a new onset of severe cough after oral fluid intake. The suspicion was confirmed by injecting methylene blue dye into the paraesophageal-extraluminal cavity during endoscopy and attesting to its presence in the respiratory tract by simultaneous bronchoscopy. Furthermore, an oral contrast computed tomography scan showed the presence of contrast in the right lower lobe of the lung. This complication was treated conservatively with EVT and antibiotics. Nutrition was administered through the existing jejunostomy. Both fistulas and the paraesophageal cavity were fully healed, oral intake was maintained, and the patient was discharged. This rare life-threatening complication can be treated conservatively. Its management is challenging, controversial, and lacks a general consensus.
PubMed: 37125383
DOI: 10.1159/000529725 -
Bioactive Materials Sep 2023In traumatized patients, the primary cause of mortality is uncontrollable continuous bleeding and unexpected intraoperative bleeding which is likely to increase the risk... (Review)
Review
In traumatized patients, the primary cause of mortality is uncontrollable continuous bleeding and unexpected intraoperative bleeding which is likely to increase the risk of complications and surgical failure. High expansion sponges are effective clinical practice for the treatment of wound bleeding (irregular/deep/narrow) that are caused by capillaries, veins and even arterioles as they possess a high liquid absorption ratio so can absorb blood platelets easily in comparison with traditional haemostasis treatments, which involve compression, ligation, or electrical coagulation etc. When in contact with blood, haemostatic sponges can cause platelet adhesion, aggregation, and thrombosis, preventing blood from flowing out from wounds, triggering the release of coagulation factors, causing the blood to form a stable polymerized fibre protein, forming blood clots, and achieving the goal of wound bleeding control. Haemostatic sponges are found in a variety of shapes and sizes. The aim of this review is to facilitate an overview of recent research around haemostatic sponge materials, products, and technology. This paper reviews the synthesis, properties, and characteristics of haemostatic sponges, together with the haemostasis mechanisms of haemostatic sponges (composite materials), such as chitosan, cellulose, gelatin, starch, graphene oxide, hyaluronic acid, alginate, polyethylene glycol, silk fibroin, synthetic polymers silver nanoparticles, zinc oxide nanoparticles, mesoporous silica nanoparticles, and silica nanoparticles. Also, this paper reviews commercial sponges and their properties. In addition to this, we discuss various in-vitro/in-vivo approaches for the evaluation of the effect of sponges on haemostasis.
PubMed: 37122895
DOI: 10.1016/j.bioactmat.2023.04.008 -
International Journal of Molecular... Apr 2023Scaffold biocompatibility remains an urgent problem in tissue engineering. An especially interesting problem is guided cell intergrowth and tissue sprouting using a...
Scaffold biocompatibility remains an urgent problem in tissue engineering. An especially interesting problem is guided cell intergrowth and tissue sprouting using a porous scaffold with a special design. Two types of structures were obtained from poly(3-hydroxybutyrate) (PHB) using a salt leaching technique. In flat scaffolds (scaffold-1), one side was more porous (pore size 100-300 μm), while the other side was smoother (pore size 10-50 μm). Such scaffolds are suitable for the in vitro cultivation of rat mesenchymal stem cells and 3T3 fibroblasts, and, upon subcutaneous implantation to older rats, they cause moderate inflammation and the formation of a fibrous capsule. Scaffold-2s are homogeneous volumetric hard sponges (pore size 30-300 μm) with more structured pores. They were suitable for the in vitro culturing of 3T3 fibroblasts. Scaffold-2s were used to manufacture a conduit from the PHB/PHBV tube with scaffold-2 as a filler. The subcutaneous implantation of such conduits to older rats resulted in gradual soft connective tissue sprouting through the filler material of the scaffold-2 without any visible inflammatory processes. Thus, scaffold-2 can be used as a guide for connective tissue sprouting. The obtained data are advanced studies for reconstructive surgery and tissue engineering application for the elderly patients.
Topics: Rats; Animals; Tissue Scaffolds; 3-Hydroxybutyric Acid; Tissue Engineering; Fibroblasts; Polyesters; Porosity
PubMed: 37108133
DOI: 10.3390/ijms24086965 -
Frontiers in Oncology 2023Neuroblastoma (NB) is children's most prevalent solid malignant tumor, accounting for 15% of childhood cancer mortality. Non-coding RNA is important in NB pathogenesis.... (Review)
Review
Neuroblastoma (NB) is children's most prevalent solid malignant tumor, accounting for 15% of childhood cancer mortality. Non-coding RNA is important in NB pathogenesis. As a newly identified non-coding RNA, abnormal regulation (abnormal up-regulation or down-regulation) of the circRNAs expression is implicated in the tumorigenesis of various tumors, including NB. CircRNAs primarily regulate the expression of microRNA (miRNA) target genes by microRNA (miRNA) sponge adsorption. Clinical evidence suggests that the expression of certain circRNAs is associated with the prognosis and clinical features of NB and hence may be exploited as a biomarker or therapeutic target. This review examines circRNAs that have been demonstrated to play a function in NB.
PubMed: 37091173
DOI: 10.3389/fonc.2023.1180300 -
Revista Portuguesa de Cardiologia :... Aug 2023The incidence of device infection has increased over time and is associated with increased mortality in patients with cardiac implantable electronic devices (CIEDs)....
INTRODUCTION AND OBJECTIVES
The incidence of device infection has increased over time and is associated with increased mortality in patients with cardiac implantable electronic devices (CIEDs). Gentamicin-impregnated collagen sponges (GICSs) are useful in preventing surgical site infection (SSI) in cardiac surgery. Nevertheless, to date, there is no evidence concerning their use in CIED procedures. Our study aims to determine the effectiveness of treatment with GICSs in preventing CIED infection.
METHODS
A total of 2986 adult patients who received CIEDs between 2010 and 2020 were included. Before device implantation, all patients received routine periprocedural systemic antibiotic prophylaxis. The study endpoints were the CIED infection rate at one year and the effectiveness of the use of GICSs in reducing CIED infection.
RESULTS
Among 1524 pacemaker, 942 ICD and 520 CRT implantations, CIED infection occurred in 36 patients (1.2%). Early reintervention (OR 9 [95% CI 3.180-25.837], p<0.001), pocket hematoma (OR 11 [95% CI 4.195-28.961], p<0.001), diabetes (OR 2.9 [95% CI 1.465-5.799], p=0.002) and prolonged procedural time (OR 1.02 [95% CI 1.008-1.034], p=0.001) were independent risk factors for CIED infection. Treatment with GICSs reduced CIED infections significantly ([95% CI -0.031 to -0.001], p<0.001).
CONCLUSIONS
The use of GICSs may help in reducing infections associated with CIED implantation.
Topics: Adult; Humans; Defibrillators, Implantable; Gentamicins; Propensity Score; Pacemaker, Artificial; Risk Factors; Prosthesis-Related Infections; Retrospective Studies
PubMed: 37085085
DOI: 10.1016/j.repc.2023.01.023 -
Alternative Therapies in Health and... Jul 2023The objective of this research study was to compare the safety and efficacy of bronchial artery embolization (BAE) using Embospheres alone versus Embospheres combined...
OBJECTIVE
The objective of this research study was to compare the safety and efficacy of bronchial artery embolization (BAE) using Embospheres alone versus Embospheres combined with gelfoam particles in patients with massive hemoptysis.
METHODS
A total of 127 patients with tuberculous massive hemoptysis who were scheduled to undergo BAE were recruited and divided into two groups: Embosphere group (E group, n = 57) and Embosphere combined with gelfoam particles group (E + G group, n = 70). Technical and clinical success were assessed after BAE surgery, and mortality, untoward reactions, and risk factors for clinical failure were recorded during follow-up.
RESULTS
The technical success rate was 92.99% in the E group and 97.14% in the E + G group (P = .272), with similar 1-year mortality rates of 1.76% and 2.86%, respectively (P = .684). However, the E group exhibited a lower clinical success rate compared to the E + G group (85.96% vs. 97.14%), and this difference was statistically significant (P = .020). The untoward reactions showed no statistically significant difference (all P > .05). Univariate analysis revealed that four factors were statistically significant: age (P = .028), presence of pulmonary cavity (P = .001), diabetes (P = .005), and a single use of Embosphere embolization (P = .020). Multivariate regression analysis demonstrated that embolization with Embosphere alone was a risk factor for clinical treatment failure (P = .025).
CONCLUSION
The combination of Embosphere with gelfoam particles can significantly improve the hemostatic effect of BAE without increasing the incidence of adverse reactions.
Topics: Humans; Gelatin Sponge, Absorbable; Hemoptysis; Bronchial Arteries; Gelatin; Embolization, Therapeutic; Treatment Outcome; Retrospective Studies
PubMed: 37083651
DOI: No ID Found -
Biomedicine & Pharmacotherapy =... Jun 2023Colorectal cancer (CRC) is the second most common cause of cancer death, leading to almost 1 million deaths per year. Despite constant progress in surgical and...
Colorectal cancer (CRC) is the second most common cause of cancer death, leading to almost 1 million deaths per year. Despite constant progress in surgical and therapeutic protocols, the 5-year survival rate of advanced CRC patients remains extremely poor. Colorectal Cancer Stem Cells (CRC-CSCs) are endowed with unique stemness-related properties responsible for resistance, relapse and metastasis. The development of novel therapeutics able to tackle CSCs while avoiding undesired toxicity is a major need for cancer treatment. Natural products are a large reservoir of unexplored compounds with possible anticancer bioactivity, sustainability, and safety. The family of meroterpenoids derived from sponges share interesting bioactive properties. Bioassay-guided fractionation of a meroterpenoids extract led to the isolation of three compounds, all cytotoxic against several cancer cell lines: Metachromins U, V and W. In this study, we evaluated the anticancer potential of the most active one, Metachromins V (MV), on patient-derived CRC-CSCs. MV strongly impairs CSCs-viability regardless their mutational background and the cytotoxic effect is maintained on therapy-resistant metastatic CSCs. MV affects cell cycle progression, inducing a block in G2 phase in all the cell lines tested and more pronouncedly in CRC-CSCs. Moreover, MV triggers an important reorganization of the cytoskeleton and a strong reduction of Rho GTPases expression, impairing CRC-CSCs motility and invasion ability. By Proteomic analysis identified a potential molecular target of MV: CCAR1, that regulates apoptosis under chemotherapy treatments and affect β-catenin pathway. Further studies will be needed to confirm and validate these data in in vivo experimental models.
Topics: Humans; Proteomics; Cell Line, Tumor; Neoplasm Recurrence, Local; Colorectal Neoplasms; Antineoplastic Agents; Neoplastic Stem Cells; Cell Cycle Proteins; Apoptosis Regulatory Proteins
PubMed: 37068332
DOI: 10.1016/j.biopha.2023.114679 -
Cureus Mar 2023Retained foreign bodies including gossypiboma could be silent for years. However, in some cases, it can lead to major complications. Gossypiboma is not frequently...
Retained foreign bodies including gossypiboma could be silent for years. However, in some cases, it can lead to major complications. Gossypiboma is not frequently reported for multiple reasons, including nonspecific presentation clinically and radiologically, and ethical issues. We present a case of a gossypiboma that was retained for more than 20 years causing a severe intestinal obstruction for an elderly female. The intestinal obstruction was initially thought to be adhesive in nature and was managed initially conservatively, but with failure to improve, the patient was taken for exploratory laparotomy, and the foreign body was found attached to the root of the mesentery posterior to the transverse colon. This case sheds light on the fact that although surgical tools are of great utility, they must be managed with utmost care to prevent complications and secure patients' safety.
PubMed: 37065417
DOI: 10.7759/cureus.36166 -
JPMA. the Journal of the Pakistan... Apr 2023Preventable morbidities are serious conditions that have the potential to cause serious harm or death of the patient. One of the preventable morbidities is Gossypiboma...
Preventable morbidities are serious conditions that have the potential to cause serious harm or death of the patient. One of the preventable morbidities is Gossypiboma or involuntary leaving of surgical sponge inside the body. The implication for the patient and the surgeon is grave. Gossypiboma is preventable if guidance and safety recommendations are followed. The purpose of presenting this case series is to rekindle awareness of the phenomena of Gossypiboma, highlight the implications, and stress prevention. Data of patients presented in the Lahore General Hospital was collected, which includes their demographic, clinical features, and management outcome. Their age, gender, surgery conducted, onset of symptoms, and salvage procedure were noted. Five cases are included in this case series from which it was concluded that Gossypiboma is encountered most commonly after intra-abdominal operation. Women are at increased risk during obstetric and gynaecological operations, though both genders are affected.
Topics: Humans; Male; Female; Foreign Bodies; Surgical Sponges; Research
PubMed: 37052008
DOI: 10.47391/JPMA.6199 -
Ophthalmology and Therapy Jun 2023Bleb scarring is the most important complication of trabeculectomy. Changing the application position of mitomycin C (MMC) during trabeculectomy might affect the surgery...
INTRODUCTION
Bleb scarring is the most important complication of trabeculectomy. Changing the application position of mitomycin C (MMC) during trabeculectomy might affect the surgery outcome. Our aim is to compare the effectiveness and safety of intraocular pressure (IOP) lowering in two different application sites of mitomycin in trabeculectomy.
METHODS
This retrospective trial compared the surgical outcomes of 177 eyes that underwent trabeculectomy with adjunctive mitomycin C. In 70 eyes, an MMC-soaked sponge was applied under the scleral flap without touching Tenon's capsule. In 107 eyes, an MMC-soaked sponge was applied under the scleral flap covered by Tenon's capsule. Outcome measures were the IOP, best-corrected visual acuity (BCVA), success rates, and incidence of complications.
RESULTS
Within both groups, a highly significant IOP reduction was seen during follow-up. The effectiveness in reducing IOP and the change in best-corrected visual acuity (BCVA) were similar between the two groups. Thin-walled blebs and postoperative hypotony were seen more often when MMC-soaked sponges were applied under the scleral flap covered by Tenon's capsule (P = 0.008 and P = 0.012, respectively). There was no significant difference in BCVA or other complications in either group.
CONCLUSION
Since the effectiveness of IOP reduction was similar between both groups and with a low incidence of thin-walled blebs and hypotony, the subscleral application without touching Tenon's capsule seems to be the safer application site of MMC during trabeculectomy.
PubMed: 37027100
DOI: 10.1007/s40123-023-00706-z