Experimental study of the possibility of topical application of polyvinylpyrrolidone for epistaxis

Nasal packing is widely used in patients with epistaxis, especially in cases where it is impossible to electrocoagulate the bleeding vessel. The disadvantages of gauze packing are well known. First of all, this is the risk of recurrent bleeding after removing the tampons from the nose. The cause of recurrent epistaxis is the activation of local fibrinolysis during prolonged stay of the tampon in the nasal cavity. To overcome this drawback, we have proposed the topical application of polyvinylpyrrolidone (PVP). In an experiment on animals, the absence of a damaging effect of PVP on mucociliary transport was proved.

Identify specific gene pairs for subarachnoid hemorrhage based on wavelet analysis and genetic algorithm

Subarachnoid hemorrhage (SAH) is a fatal stroke caused by bleeding in the brain. SAH can be caused by a ruptured aneurysm or head injury. One-third of patients will survive and recover. One-third will survive with disability; one-third will die. The focus of treatment is to stop bleeding, restore normal blood flow, and prevent vasospasm. Treatment for SAH varies, depending on the bleeding’s underlying cause and the extent of damage to the brain. Treatment may include lifesaving measures, symptom relief, repair of the bleeding vessel, and complication prevention. However, the useful diagnostic biomarkers of SAH are still limited due to the instability of gene marker expression. To overcome this limitation, we developed a new protocol pairing genes and screened significant gene pairs based on the feature selection algorithm. A classifier was constructed with the selected gene pairs and achieved a high performance.

Rupture of Dorsal Vein Mimicking Penile Fracture: a Case Series Report and Literature Review

Penile fracture is a rare and traumatic emergency in andrology. Immediate surgical repair is widely accepted as the therapy of choice in penile fracture. But some situations mimic penile fracture such as superficial dorsal vein rupture. There are few cases reported in the literature. Aim: To present a case series of injuries of the penile dorsal vein that occurred during sexual intercourse. Methods: A 48-year-old and 45-year-old patients both received in emergency for suspected penile fracture after one hour of vigorous sexual intercourse, the clinical examination and ultrasound were performed and the penile fracture was suspected. Surgical management in an emergency was indicated. Results: Per-operative diagnosis was a dorsal vein injury. The surgical management which consisted of early exploration, evacuation of hematoma, and ligation of the bleeding vessel in this case was good with preserving erectile function after surgery, without abnormal curvature erection. Conclusions: Vascular injuries of the penis can mimic perfectly penile fractures. The medical history and clinical examination can lead to prompted exploration for suspected penile fracture. The ultrasound exploration can be limited for detection of penile vascular injury and final surgical exploration offers final diagnosis and repairment of the trauma. Clinical evolution is favorable, without painful nocturnal erections or deviation of the penis or hypoesthesia of the glans.

Absorbable Self-Retaining Barbed Double-Needle Suture(SRBDS) in Transperitoneal Laparoscopic Partial Nephrectomy for T1 Renal Neoplasms

ObjectiveTo evaluate the safety and hemostatic efficacy of absorbable self-retaining barbed double-needle suture (SRBDS) in transperitoneal LPN for T1 renal neoplasms.MethodsIn total, 75 patients with renal neoplasm masses (< 7 cm) undergoing transperitoneal LPN were collected since January 2018 to October 2019. After tumor resection with a cold Endoscissor, 3-0 and 0 SRBDS was performed for inner and outer running stitches without either hem-o-lok or LapraTy clip, respectively. Patient demographic information, neoplasm characteristics, perioperative factors, and oncologic outcomes were collected and analyzed.ResultsAccording to our result, Median tumor size and R.E.N.A.L score was 4.69 cm and 7. Median operative time and overall warm ischemia time was 73 min and 13.14 min. Mean estimated blood loss was 67 ml. intraoperative complications was not showing up and no case was switched to open radical nephrectomy. Postoperative pathological assessment confirmed that negative surgical margins. only single patient experienced secondary surgery-related hemorrhage on the fifth day post-operation, and was treated by transfusion and digital subtraction angiography (DSA) highly selective embolization of the bleeding vessel. No patients developed urinoma or urinary fistula. the overall complications were manageable during three-year follow-up period.ConclusionSRBDS was a safe and efficient surgical endoscopic suturing technique with low complication rate in T1 renal neoplasms, which might be considered as an alternative to other suturing techniques, tissue sealants and glues for partial nephrectomy in the future.

A rare and overlooked cause of massive gastrointestinal bleeding: Distal duodenal GIST

Introduction. Gastrointestinal stromal tumors (GIST) are tumors of mesenchymal origin which originate from the walls of gastrointestinal system (GIS) organs. Aim. In this case report we aim to discuss the clinical, labaratory and radiological presentation of distal duodenal GIST as a rare and overlooked cause of life-threatining GIS bleeding. Description of the case. A 76-year-old male patient was presented to the emergency department with massive gastrointestinal bleeding. Computerized tomography revealed a mass soft tissue density of 4x4cm at the level of the 3-4th segment of the duodenum. At the endoscopy, there was a deep ulcer in the proximal part of the 3rd segment of the duodenum with a diameter of 2 cm with a bleeding vessel protruding into the lumen. After endoscopic treatments, biopsies were taken from the edges of the ulcer. Histopathological examination revealed a sheet-like infiltration composed of mildly pleomorphic cells with oval-spindle nuclei and abundant eosinophilic cytoplasm in the duodenal lamina propria, as the patient was diagnosed of GIST. Conclusion. GIST and its clinical, labaratory and radiological presentation should be kept in mind in the approach to massive duodenal GIS bleeding.

Preemptive non-selective bronchial artery angioembolization to reduce recurrence rate of hemoptysis

Background: Massive hemoptysis which is presented in advanced lung diseases is a life-threatening condition. Bronchial artery embolization as a minimally invasive procedure is the treatment of choice either in first or recurrent hemoptysis. This study aimed to assess the early and late efficacy of bronchial angioembolization (BAE) without microcatheter.Methods: In this prospective cohort study, all patients with hemoptysis who had undergone BAE from August 2018 to March 2019 were included. Angiographic patterns including bleeding sources, number of involved vessels, the underlying etiology, and recurrence rate were evaluated in a one-year follow-up.Results: 153 patients were included with mean age of 55 ±16 years. 68% of them were male and 58% had life-threatening massive hemoptysis. Three distinct angiographic patterns were recognized. The culprit bleeding vessel was bronchial in 126 (92%), intercostal in 4 (3%), and both vessels in 7 (5%) of cases (P<0.05). One vessel involvement was seen in 56 patients; however it was observed in 69% of non-cystic fibrosis lobar bronchiectasis patients. In 1, 3 and 12 months follow up, recurrent hemoptysis was reported in 15 (11%), 4 (2.5%), and 24 (15.5%), respectively. In 52% of cases, no abnormal vessels were observed during aorta injection, but culprit bronchial or intercostal arteries were found in selective investigational angiography.Conclusion: BAE was successful in the control of hemoptysis and resulted in a low rate of recurrence in different types of lung diseases. This could be due to the embolization of all pathological arteries found during angiography which might have prevented recurrent bleeding.

Art, craft and science of limb amputation Part 1. Art and craft of amputation: from Hippocrates to Ambroise Pare (V century B.C. – XVI century)

Limb amputation is one of the oldest and most famous operation in surgery. Over the millennia, the tools for its implementation and the technique for its perfomance have been constantly improved. In part 1 of the article, using historical, chronological and dialectical methods, as well as the method of comparative content analysis a number of printed (Hippocrates, V-IV centuries B.C.; Celsus, I century; Abu-alQasim, XI century; A. Paré, XVI century, etc.), material (prostheses, surgical instruments) and visual (engraving, painting, etc.) sources, the circumstances and features of the emergence and development of instruments and techniques for limbs amputation from antiquity to the era were studied and recreated Renaissance. The main indication for amputation was the limb death (gangrene), as well as significant tissue trauma caused by cold or firearms (since the XIV century). The limb was truncated (or isolated) with a circular section along the demarcation line (in ancient times) or within healthy tissues (in the Middle Ages). The operation was carried out under a tourniquet applied above the level of amputation; healthy tissues were shifted proximally; sometimes a second tourniquet was applied - below the cut-off level. Anesthesia was achieved by operating in a state of painful shock, after bloodletting, or by applying a tight ligature (tourniquet). Bleeding was stopped with the surgeon's finger, cauterization or vessel cutting of, ligature of one vessel or the entire bleeding tissue (en masse), suturing of the bleeding vessel (A. Paré), as well as astringents and a bandage. The wound of the stump was left open or brought together with sutures. A major stage in the development of amputation was the work of A. Paré (XVI century), who improved instruments (in particular, clamps for stopping bleeding), the technique of the operation, and pain relief during its performance. If in the Ancient World and in the early Middle Ages amputation was life-threatening, available only to a few of the most skilled doctors, was performed relatively rarely and was akin to art, then after its development in the XIII–XIV centuries. barbers began to perform it everywhere, routinely and gradually turned into a craft. Further development of indications for amputation, techniques for its implementation and the transformation of this operation from a craft into a science from the XVII century. until the middle of the twentieth century will be reflected in part 2 of this article.

Absorbable self-retaining barbed double-needle suture(SRBDS) in transperitoneal laparoscopic partial nephrectomy for T1 renal neoplasms

PurposeThe purpose of study was to evaluate the safety and hemostatic efficacy of absorbable self-retaining barbed double-needle suture (SRBDS) in transperitoneal LPN for T1 renal neoplasms.MethodsIn total, 75 patients with renal neoplasm masses (< 7 cm) undergoing transperitoneal LPN were collected since January 2018 to October 2019. After tumor resection with a cold Endoscissor, 3-0 and 0 SRBDS was performed for inner and outer running stitches without either hem-o-lok or LapraTy clip, respectively. Patient demographic information, neoplasm characteristics, perioperative factors, and oncologic outcomes were collected and analyzed. ResultsAccording to our result, Median tumor size and R.E.N.A.L score was 4.69 cm and 7. Median operative time and overall warm ischemia time was 73 min and 13.14 min. Mean estimated blood loss was 67 ml. intraoperative complications was not showing up and no case was switched to open radical nephrectomy. Postoperative pathological assessment confirmed that negative surgical margins. only single patient experienced secondary surgery-related hemorrhage on the fifth day post-operation, and was treated by transfusion and digital subtraction angiography (DSA) highly selective embolization of the bleeding vessel. No patients developed urinoma or urinary fistula. the overall complications were manageable during three-year follow-up period. ConclusionSRBDS was a safe and efficient surgical endoscopic suturing technique with low complication rate in T1 renal neoplasms, which might be considered as an alternative to other suturing techniques, tissue sealants and glues for partial nephrectomy in the future.

Endoscopic hemostasis in the ulcer gastro-duodenal hemorrhage, using high-frequency biological welding electro-ligature

Objective. To improve the efficacy of endoscopic hemostasis for the ulcer gastro-duodenal hemorrhage, using high-frequency biological welding electro-ligature. Materials and methods. In 2017-2020 yrs period the analysis of efficacy of endoscopic hemostasis was done in 160 patients, ageing 40-85 yrs old, for the ulcer gastro-duodenal hemorrhage. The patients were distributed into two groups: the main - 80 patients, in whom high-frequency biological welding electro-ligature was performed, and a control one - 80 patients, in whom monopolar thermal argon-plasm coagulation was conducted. Results. In the main Group a primary hemostasis was achieved in 77 (96.3%) patients. Early recurrence of hemorrhage have occurred in 3 (3.8%) patients. In a control Group a primary hemostasis was achieved in 66 (82.5%) patients. Recurrence of the hemorrhage have occurred in 14 (17.5%) patients. Conclusion. Endoscopic hemostasis for the ulcer gastro-duodenal hemorrhage, using high-frequency biological welding electro-ligature, is achieved due to the impedance action of modulated signal of a high-frequency current as well as the adaptive system of automatic guidance of the welding process and a contact between special endoscopic probe, owing a concave electrode, with bleeding vessel, leading to its complete obliteration. Application of welding electro-ligature for endoscopic hemostasis in the ulcer gastro-duodenal hemorrhage, using high-frequency biological welding electro-ligature, guarantees more secure residual hemostasis, than application of monopolar thermal argon-plasm coagulation, peculiarly in hemorrhage from vessels owing 2 - 4 mm diameter. As a result, the hemorrhage recurrence rate have had reduced down to 3.8% (in the control Group - 18.0%).