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International Wound Journal Oct 2023Surgical site infection (SSI) is common following arterial surgery involving a groin incision. There is a lack of evidence regarding interventions to prevent groin wound... (Randomized Controlled Trial)
Randomized Controlled Trial
Surgical site infection (SSI) is common following arterial surgery involving a groin incision. There is a lack of evidence regarding interventions to prevent groin wound SSI, therefore, a survey of vascular clinicians was undertaken to assess current opinion and practice, equipoise and feasibility of a randomised controlled trial (RCT). Participants at the Vascular Society of Great Britain and Ireland 2021 Annual Scientific Meeting were surveyed regarding three separate interventions designed to prevent SSI in the groin; impregnated incise drapes, diakylcarbomoyl chloride dressings and antibiotic impregnated collagen sponges. Results were collated via an online survey using the Research Electronic Data Capture platform. Seventy-five participants completed the questionnaire, most were consultant vascular surgeons (50/75, 66.7%). The majority agree that groin wound SSI is a major problem (73/75, 97.3%), and would be content using either of the three interventions (51/61, 83.6%) and had clinical equipoise to randomise patients to any of the three interventions versus standard of care (70/75, 93.3%). There was some reluctance to not use impregnated incise drapes as may be considered "standard of care". Groin wound SSI is perceived as major problem in vascular surgery, and a multicentre RCT of three preventative interventions appears acceptable to vascular surgeons.
Topics: Humans; Groin; Surgical Wound Infection; Feasibility Studies; Vascular Surgical Procedures; Surveys and Questionnaires; Surgical Wound
PubMed: 37433749
DOI: 10.1111/iwj.14170 -
Annals of Medicine and Surgery (2012) Jul 2023Retained surgical item is a known incidental surgical complication that is a mass of a sponge. This cotton matrix is left behind in the body cavity after surgical...
UNLABELLED
Retained surgical item is a known incidental surgical complication that is a mass of a sponge. This cotton matrix is left behind in the body cavity after surgical procedures. It is an incidental, rare medical error.
CASE PRESENTATION
Here, the authors present a case of a 30-year-old woman who had undergone a cesarean section 2 months ago and presented with the cardinal symptoms of small bowel obstruction. A computerized abdominal tomography (CT) scan showed a well-defined tubular hyperdense structure adherent to the anterior abdominal wall that exerts a mass effect on the adjacent small bowel loops. Following the computerized abdominal tomography results, an exploratory laparotomy resection and anastomosis of a small segment of the ileum were performed. The postoperative period was uneventful, and the patient has remained disease-free to date.
CLINICAL DISCUSSION
Because it is not anticipated, and its clinical manifestations are variable, it is frequently misdiagnosed, and often unnecessary radical surgical procedures are performed.
CONCLUSION
It should be considered in the differential diagnosis of any postoperative case with an unresolved or unusual presentation.
PubMed: 37427222
DOI: 10.1097/MS9.0000000000000992 -
Korean Journal of Radiology Jul 2023Transarterial chemoembolization (TACE) was introduced in 1977 with the administration of chemotherapeutic agent to gelatin sponge particles through the hepatic artery in... (Review)
Review
Transarterial chemoembolization (TACE) was introduced in 1977 with the administration of chemotherapeutic agent to gelatin sponge particles through the hepatic artery in patients with hepatocellular carcinoma (HCC) and was established as conventional TACE using Lipiodol in the 1980s. In the 2000s, drug-eluting beads were developed and applied clinically. Currently, TACE is a commonly used non-surgical treatment modality for patients with HCC who are unsuitable for curative treatment. Considering the vital role of TACE in the management of HCC, it is crucial to organize current knowledge and expert opinions regarding patient preparation, procedural techniques, and post-treatment care in TACE, which can enhance therapeutic efficacy and safety. A group of 12 experts in the fields of interventional radiology and hepatology, convened by the Research Committee of the Korean Liver Cancer Association (KLCA), has developed expert consensus-based practical recommendations in TACE. These recommendations have been endorsed by the Korean Society of Interventional Radiology and provide useful information and direction in performing TACE procedure as well as pre- and post-procedural patient care.
Topics: Humans; Carcinoma, Hepatocellular; Liver Neoplasms; Consensus; Chemoembolization, Therapeutic; Republic of Korea
PubMed: 37404104
DOI: 10.3348/kjr.2023.0385 -
Cureus May 2023The WHO launched the "Safe Surgery Saves Lives" campaign in 2008 to improve patient safety during surgery. The campaign includes the use of the WHO Surgical Safety...
BACKGROUND AND OBJECTIVE
The WHO launched the "Safe Surgery Saves Lives" campaign in 2008 to improve patient safety during surgery. The campaign includes the use of the WHO Surgical Safety Checklist, which has been proven effective in reducing complications and mortality rates in several studies. This article discusses a clinical audit at a tertiary healthcare facility that assesses compliance with all three components of the checklist to minimize errors and improve safety standards.
MATERIALS AND METHODS
This prospective, observational, closed-loop clinical audit study was conducted at Hayatabad Medical Complex, a tertiary care public sector hospital located in Peshawar, Pakistan. The audit aimed to assess compliance with the WHO Surgical Safety Checklist. The first phase of the audit cycle commenced on October 5, 2022, and involved collecting data from 91 surgical cases in randomly selected operating rooms. Following the completion of the first phase on December 13, 2022, an educational intervention was then conducted on December 15 to underscore the significance of adhering to the checklist, and the second phase of data collection began the following day, ending on February 22, 2023. The results were analyzed using SPSS Statistics version 27.0.
RESULTS
The first phase of the audit showed that there was poor compliance with the latter two parts of the checklist. Certain components of the WHO Surgical Safety Checklist were well-complied with, including patient identity confirmation (95.6%), obtaining informed consent (94.5%), and counting of sponges and instruments (95.6%), while the lowest compliance rates were in recording allergies (26.3%), assessing blood loss risk (15.3%), introducing team members (62.6%), and inquiring about patient recovery concerns (64.8%, 34%, and 20.8% for surgeons, anesthetists, and nurses, respectively). In the second phase, after an educational intervention, compliance with the checklist improved significantly, particularly for those components with low compliance rates in the first phase, marking recording allergies (89.0%), introducing team members 91.2%), and inquiring about patient recovery concerns (79.1%, 73.6%, and 70.3% for surgeons, anesthetists, and nurses, respectively).
CONCLUSION
The study showed that education is a critical factor in improving compliance with the WHO Surgical Safety Checklist. The study suggests that overcoming the obstacles to implementing the checklist requires a collaborative environment and effective instruction. It emphasizes the importance of adhering to the checklist in all surgical settings.
PubMed: 37398744
DOI: 10.7759/cureus.39808 -
World Journal of Gastrointestinal... Jun 2023Endoscopic vacuum therapy (EVT) is an increasingly popular treatment option for wall defects in the upper gastrointestinal tract. After its initial description for the... (Review)
Review
Endoscopic vacuum therapy (EVT) is an increasingly popular treatment option for wall defects in the upper gastrointestinal tract. After its initial description for the treatment of anastomotic leaks after esophageal and gastric surgery, it was also implemented for a wide range of defects, including acute perforations, duodenal lesions, and postbariatric complications. Apart from the initially proposed handmade sponge inserted using the "piggyback" technique, further devices were used, such as the commercially available EsoSponge and VAC-Stent as well as open-pore film drainage. The reported pressure settings and intervals between the subsequent endoscopic procedures vary greatly, but all available evidence highlights the efficacy of EVT, with high success rates and low morbidity and mortality, so that in many centers it is considered to be a first-line treatment, especially for anastomotic leaks.
PubMed: 37397978
DOI: 10.4253/wjge.v15.i6.420 -
Journal of Surgical Case Reports Jun 2023During any surgical procedure, complications may arise, some of which are fortuitous, whereas others, unfortunately, occur because of errors of the surgical team....
During any surgical procedure, complications may arise, some of which are fortuitous, whereas others, unfortunately, occur because of errors of the surgical team. Fortunately, most are minor and do not affect the patient's recovery, but others can cause severe morbidity and even mortality. A retained cotton or gauze surgical sponge inadvertently left in the body during an operation is known as a gossypiboma. This dreadful oversight is a marked complication that can cause serious postoperative complications, a severe economic burden on the healthcare system, and many medicolegal implications. We report the case of a 30-year-old male, who suffered a spinal fracture which was repaired through an anterior fixation approach 12 years ago in a local state hospital without complications. Suddenly, he presented with chest pain and cough, and sought medical attention. An 8 × 5 × 8 cm low-density heterogeneous mass was discovered on his chest; after successful surgery, a gossypiboma formed by several gauzes without radiopaque markers was discovered.
PubMed: 37337532
DOI: 10.1093/jscr/rjad328 -
Medicine Jun 2023Pheochromocytomas are a group of tumors with high genetic heterogeneity, and the clinical characteristics of rearranged during transfection (RET)-mutated...
RATIONALE
Pheochromocytomas are a group of tumors with high genetic heterogeneity, and the clinical characteristics of rearranged during transfection (RET)-mutated pheochromocytoma with medullary spongiform kidney are rarely studied. The treatment process of 1 patient with bilateral adrenal pheochromocytoma combined with medullary sponge kidney with RET gene mutation in our department was retrospectively analyzed, and the treatment methods for this type of disease were studied and summarized in combination with relevant literature.
PATIENT CONCERNS
In this case, the patient was found to have bilateral adrenal masses for 8 years due to physical examination, and intermittent dizziness and discomfort for 2 years. Imaging and related laboratory examinations suggest bilateral adrenal giant pheochromocytoma with bilateral medullary sponge kidney. RET gene testing was performed on the patient and his descendant after signing the informed consent form.
DIAGNOSES
The patient was diagnosed with bilateral adrenal pheochromocytoma with a RET proto-oncogene mutation and a bilateral medullary spongy kidney.
INTERVISION AND OUTCOMES
After sufficient perioperative preparation, retroperitoneal laparoscopic bilateral adrenal pheochromocytoma resection was performed by stages. The operation was successful, and hormone replacement therapy was performed after the operation, with regular follow-up. Relevant genetic testing revealed that the c.1900T > C: p.C634R mutation was detected in the patient's RET gene, which was a heterozygous missense mutation, and the mutation was also present in the son of his family. A literature analysis found that pheochromocytoma is a tumor with high genetic heterogeneity, and the RET proto-oncogene is a common pathogenic gene for bilateral adrenal pheochromocytoma. Medullary sponging of kidneys is a rare complication of this disease.
LESSONS
On the basis of adequate perioperative preparation, surgical resection is the most effective and preferred treatment for this type of disease. Laparoscopic surgery is minimally invasive, safe, and effective by stages. Mutations in the RET proto-oncogene may lead to medullary spongy kidneys in multiple endocrine neoplasia 2.
Topics: Humans; Pheochromocytoma; Multiple Endocrine Neoplasia Type 2a; Medullary Sponge Kidney; Retrospective Studies; Proto-Oncogene Proteins c-ret; Proto-Oncogene Mas; Mutation; Adrenal Gland Neoplasms; Proto-Oncogenes; Thyroid Neoplasms
PubMed: 37335636
DOI: 10.1097/MD.0000000000034022 -
Journal of Clinical Neuroscience :... Aug 2023Rapid and efficacious haemostasis is paramount in neurosurgery. Assessing the efficacy and short- and long-term safety of haemostatic agents utilised within cerebral...
OBJECTIVE
Rapid and efficacious haemostasis is paramount in neurosurgery. Assessing the efficacy and short- and long-term safety of haemostatic agents utilised within cerebral tissue is essential. This pilot study investigates the haemostatic efficacy and long-term safety of a novel beta-chitin patch against traditionally used agents, bipolar and Floseal, within cerebral tissue.
METHODS
Eighteen Merino sheep underwent standardised distal cortical vessel injury via temporal craniotomy. Sheep were randomised to receive 2 mls Floseal, 2 cm novel beta-chitin patch, or bipolar cautery to manage bleeding. All sheep underwent cerebral magnetic resonance imaging (MRI) at three months, before euthanasia and brain harvesting for histological assessment.
RESULTS
Beta-chitin demonstrated a trend towards a faster mean time to haemostasis (TTH) compared to Floseal (223.3 ± 199 s v. 259.8 ± 186.4 s), albeit non-significant (p = 0.234). Radiologically, cerebrocortical necrosis (p = 0.842) and oedema (p = 0.368) were noted slightly more frequently in the beta-chitin group. Histologically, severe fibrotic (p = 0.017) and granulomatous changes at the craniotomy sites were only present in the beta-chitin group (p = 0.002). Neuronal degeneration was seen in all with Floseal, but beta-chitin showed a trend towards more severe reaction when present. Bipolar use predominantly showed an inflammatory cortical reaction with substantial microvascular proliferation, and Floseal showed worse severity and depth of subpial oedema, however no statistical significance was reached.
CONCLUSION
All haemostats controlled bleeding, with beta-chitin demonstrating a non-inferior TTH compared to Floseal. However, it resulted in intense granulomatous and fibrotic changes, including degenerative neuronal reactions. More extensive studies are needed to assess these trends, to make further clinical inferences.
Topics: Sheep; Animals; Hemostatics; Pilot Projects; Gelatin Sponge, Absorbable; Hemostasis; Hemostasis, Surgical; Chitin
PubMed: 37321020
DOI: 10.1016/j.jocn.2023.06.001 -
Clinical Case Reports Jun 2023Intravesical textiloma is a rare surgical complication, that may cause nonspecific lower urinary tract symptoms. Clinicians should consider it in patients with a history...
KEY CLINICAL MESSAGE
Intravesical textiloma is a rare surgical complication, that may cause nonspecific lower urinary tract symptoms. Clinicians should consider it in patients with a history of bladder surgery and persistent or new-onset urinary symptoms.
ABSTRACT
Intravesical textiloma is a rare condition usually presents asymptomatic or with non specific symptoms. A 72 years old man with prior open prostatectomy presented lower urinary tract symptoms and diagnosed with bladder stones, explorative laparotomy revealed semi calcified gauze. Similar history should prompt suspicion of this condition.
PubMed: 37305858
DOI: 10.1002/ccr3.7434 -
Clinical Implant Dentistry and Related... Oct 2023Different biomaterials were suggested for sinus floor augmentation (SFA). Recently, new materials were launched showing true bone formation without remnants.
BACKGROUND
Different biomaterials were suggested for sinus floor augmentation (SFA). Recently, new materials were launched showing true bone formation without remnants.
PURPOSE
The aim of this prospective study was to evaluate an hydroxyapatite-based, sugar cross-linked collagen sponge (OSSIX™ Bone) in transcrestal SFA (t-SFA).
MATERIALS AND METHODS
Twenty-four patients with edentulous posterior maxilla and residual bone height (RBH) >4 mm underwent t-SFA with OSSIX™ Bone as grafting material and simultaneous implant placement. The implant Stability Quotient (ISQ) was measured by resonance frequency analysis (RFA) directly after implant insertion and at 6 months. Differences in bone height (BH) and volume were determined in CBCT and x-rays at baseline versus 1 year of follow-up. Graft volume was evaluated by tridimensional reconstructions. Linear regression analysis was used to evaluate the effect of bucco-palatal sinus dimension, RBH, and length of the implant protruding (PIL) into the sinus, on the graft height (GH) changes up to 1 year, and on the graft volume at 1 year. Autocorrelation between time lag and augmented bone volume was evaluated through time series analysis correlograms. Health-related quality-of-life outcomes were captured.
RESULTS
Twenty-two patients completed the study. The mean RBH measured at baseline was 5.81 ± 2.2 mm. The mean graft volume was 1085.8 ± 733.4 mm . The mean GH, measured in the immediate post-operative period, at 6 and 12 months respectively, was 7.24 mm ±1.94; 6.57 mm ± 2.30; 5.46 mm ± 2.04. The mean ISQ measured after the implant placement was 62.19 ± 8.09, and 6 months later was 76.91 ± 4.50. There was a significant correlation between buccolingual dimension and graft volume at 1 year. Neither buccolingual volume nor RBH had a significant effect on GH change, while the PIL showed a significant positive correlation (P = 0.02 and P = 0.03 at 6 and 12 months, respectively). The correlograms indicated no significant correlation, meaning that there is no tendency for graft volume to increase or decrease over time, therefore suggesting graft stability, at least up to one year of follow-up. 86% of patients had no chewing interference.
CONCLUSION
Within the limitations of the study, OSSIX™ Bone could be considered a valid material for SFA due to its manageability and its positive results in promoting new bone formation with long-term stability. T-SFA is confirmed as a less invasive and less painful method.
Topics: Humans; Sinus Floor Augmentation; Dental Implantation, Endosseous; Pilot Projects; Prospective Studies; Durapatite; Maxillary Sinus; Maxilla; Dental Implants
PubMed: 37288709
DOI: 10.1111/cid.13236