Ultrasound-guided preoperative localization of radial nerve in the treatment of extra-articular distal humeral shaft fractures

Background The aim of this study was to discuss the treatment of extra-articular distal humeral shaft fractures using ultrasound-guided preoperative localization of radial nerve. Methods Between May 2010 and December 2019, 56 patients with extra-articular distal humeral shaft fractures were retrospectively reviewed. Twenty eight patients were received examination by using preoperative localization of radial nerve guided by ultrasound-guided preoperative localization (group A) and 28 control patients without ultrasound-guided (group B). All patients were treated surgically for distal humeral shaft fractures by posterior approach techniques. Operative time, radial nerve exposure time, intraoperative bleeding volume, union time and iatrogenic radial nerve palsy rate were compared between the two groups. Elbow function was also evaluated using the Mayo Elbow Performance Score (MEPS). Results A significant difference was observed between the two groups, Operative time (113.25 min vs 135.86 min) (P < 0.001), radial nerve exposure time (20.82 min vs 32.53 min) (P < 0.001), intraoperative bleeding volume (246.80 ml vs 335.52 ml) (P < 0.001). However, iatrogenic radial nerve palsy rate (3.6% vs 7.1%) (P = 0.129), the fracture union time (13.52 months vs 12.96 months) (P = 0.796) and the MEPS score (87.56 vs 86.38) (P = 0.594) were no significantly different in both groups. Conclusions The study demonstrates that ultrasound-guided preoperative localization is an effective approach in the treatment of extra-articular distal humeral shaft fracture by revealing radial nerve, which may help reduce the operative time, radial nerve exposure time and the intraoperative bleeding volume.

Bismuth Subgallate as a Local Hemostatic Agent

Background: Patients on clopidogrel increased bleeding risk after surgery. This drug prolonged bleeding time, increased bleeding volume and induced secondary bleeding because its active metabolite inhibited platelets aggregation and interfered with haemostatic plug stabilization. Conventional methods, such as pressing sterile gauze on the surgery site, showed less effective to stop bleeding in patients on clopidogrel. This research aims to prove the haemostatic effect of bismuth subgallate both on normal and delayed platelet aggregation due to clopidogrel.Methods: Twenty-eight Wistar rats were equally and randomly administered with clopidogrel (10 mg/kgBW) or NaCl 0.9% (saline) via oral gavage. After anesthetizing, we amputated transversely their tail 10 mm from the distal tip. Bleeding after amputation was controlled with pressing gauze soaked in saline or bismuth subgallate solution. After 60 seconds, bleeding assays (bleeding time, bleeding volume, and secondary bleeding) have been observed, recorded, and analysed both in normal and clopidogrel groups.Results: Clopidogrel groups had significantly longer bleeding time, greater bleeding volume, and had more secondary bleeding rather than saline groups (p <.05). Using bismuth subgallate as local haemostatic agent decreased bleeding time and bleeding volume significantly (p <.05) both in normal and clopidogrel groups. Conclusions: Bismuth subgallate has a haemostatic effect on both clopidogrel and normal rat tail bleeding models.

Application of Hip Amputation Under Non-Ischemic Condition in the Treatment of Sarcomar

Background: Amputation is an effective treatment for sarcoma of the hip. Traditional amputation is performed by separating the major arteries and veins of the limb and blocking the blood supply to the limb, which may have adverse effects on the patient.Methods: Ten patients with pathologically clearly diagnosed bone and soft tissue sarcoma undergoing hip amputation in a non-ischemic state between April 2019 and April 2021 at the Affiliated Cancer Hospital of Harbin Medical University were selected. Factors related to operative time, intraoperative bleeding, phantom limb pain, incisional infection, and flap necrosis were statistically evaluated at 7 days postoperatively and 3 months postoperatively.Results: Ten patients were followed up for 3-24 months with a mean of 13 months. No bleeding secondary surgical complications occurred in all patients, and none had postoperative infections. Postoperative flap necrosis occurred in one case in the modified hemipelvic amputation patients, and no flap necrosis occurred in the hip disarticulation patients. In the non-ischemic hemipelvic amputation group, the operation time was 4.5-5.5h, with a mean of 5h, and the operation bleeding volume was 300-1000ml, with a mean of 700ml; in the hip disarticulation group, the operation time was 2.5-3.5h, with a mean of 2.9h, and the operation bleeding volume was 300-450ml, with a mean of 357ml; phantom limb pain in the non-ischemic amputation group 7 days after operation, the VAS pain score was 4 -6 points, mean 4.5 points; VAS pain score 3-4 points, mean 3.4 points at 3 months postoperatively.Conclusions: In hip amputation for bone and soft tissue sarcoma, the main arterial and venous approaches to the limb are ligated near the end of surgery, leaving the amputated limb in a non-ischemic state at the distal end of the amputation, without pathological reactions due to limb ischemia. Non-ischemic hip amputation is more suitable for the surgical treatment of locally advanced lesions of sarcoma.Trial registration: retrospectively registered

Use of laboratory testing for prediction of postoperative bleeding volume in cardiovascular surgery

Background Coagulopathy and following massive bleeding are complications of cardiovascular surgery, particularly occurring after procedures requiring prolonged cardiopulmonary bypass (CPB). Reliable and rapid tests for coagulopathy are desirable for guiding transfusion. Measuring multiple coagulation parameters may prove useful. The purpose of this study is to determine the laboratory parameters predicting massive bleeding. Methods In a prospectively collected cohort of 48 patients undergoing cardiovascular surgery, markers of coagulation and fibrinolysis were measured using automated analyzer and their correlations with bleeding volume were determined. Results Operation time was 318 (107–654) min. CPB time was 181 (58–501) min. Bleeding volume during surgery was 2269 (174–10,607) ml. Number of transfusion units during surgery were packed red blood cells 12 (0–30) units, fresh frozen plasma 12 (0–44) units, platelets 20 (0–60) units and intraoperative autologous blood collection 669 (0–4439) ml. Post-surgery activities of coagulation factors II (FII), FV, FVII, FVIII, FIX, FX, FXI and FXII were decreased. Values of fibrinogen, antithrombin, α2 plasmin inhibitor (α2PI) and FXIII were also decreased. Values of thrombin-antithrombin complex (TAT) were increased. Values of FII, FIX, FXI and α2PI before surgery were negatively correlated with bleeding volume (FII, r = − 0.506: FIX, r = − 0.504: FXI, r = − 0.580; α2PI, r = − 0.418). Level of FIX after surgery was negatively correlated with bleeding volume (r = − 0.445) and level of TAT after surgery was positively correlated with bleeding volume (r = 0.443). Conclusions These results suggest that several clinical and routine laboratory parameters of coagulation were individually associated with bleeding volume during cardiovascular surgery. Determining the patterns of coagulopathy may potentially help guide transfusion during cardiovascular surgery.

Post-Cardiotomy Pericardial Effusion and Postoperative Atrial Fibrillation Risk

PurposePostoperative atrial fibrillation is a poor prognostic factor that increases mortality rates. We have observed that patients who experienced significant pericardial effusion developed postoperative atrial fibrillation; however, little research has been conducted examining the association between postoperative atrial fibrillation and post-cardiotomy pericardial effusion.MethodsThis retrospective, single-center study included adult patients who underwent cardiovascular surgery via median sternotomy from January 2016 to December 2019. Patients who underwent routine postoperative computed tomography at 7±3 days after surgery (n = 294) were included. Pericardial effusion was measured at its thickest point. Patients were classified into groups with (n = 127) and without (n = 167) postoperative atrial fibrillation, and the association of pericardial effusion with other factors was evaluated. A possible confounder adjusted logistic regression analysis after multiple imputation was performed to obtain odds ratios for postoperative atrial fibrillation using previously published risk factors.ResultsAge, intraoperative bleeding volume, and pericardial effusion size were all significantly higher in the group with postoperative atrial fibrillation. Multivariate logistic regression after multiple imputation revealed that age, intraoperative bleeding volume, and postoperative pericardial effusion were significantly associated with postoperative atrial fibrillation.ConclusionTo our knowledge, this is the first study focusing on the relationship between post-cardiotomy pericardial effusion and postoperative atrial fibrillation. Our findings showed that post-cardiotomy pericardial effusion is associated with postoperative atrial fibrillation. However, causality remains unknown, making further studies mandatory.

Ultrasound-guided Preoperative Localization of Radial Nerve in the Treatment of Extra-articular Distal Humeral Shaft Fractures

Background: The aim of this study was to discuss the treatment of extra-articular distal humeral shaft fractures using ultrasound-guided preoperative localization of radial nerve.Methods: Between May 2014 and December 2019, 56 patients with extra-articular distal humeral shaft fractures were retrospectively reviewed. 28 patients were received examination by using preoperative localization of radial nerve guided by ultrasound-guided preoperative localization (group A) and 28 control patients without ultrasound-guided (group B). All patients were treated surgically for distal humeral shaft fractures by posterior approach techniques. Operative time, radial nerve exposure time, intraoperative bleeding volume, union time and iatrogenic radial nerve palsy rate were compared between the two groups. Elbow function was also evaluated using the Mayo Elbow Performance Score (MEPS). Results: A significant difference was observed between the two groups, Operative time (113.25 min vs 135.86 min) (p < 0.001), radial nerve exposure time (20.82 min vs 32.53 min) (p < 0.001), intraoperative bleeding volume (246.80 ml vs 335.52 ml) (p < 0.001) and iatrogenic radial nerve palsy rate (0 vs 10.7% ) (p< 0.001). However, the fracture union time (13.52 months vs 12.96 months) (p = 0.796) and the MEPS sscore (87.56 vs 86.38) (p = 0.594) were no significantly different in both groups. Conclusion: The study demonstrates that ultrasound-guided preoperative localization is an effective approach in the treatment of extra-articular distal humeral shaft fracture by revealing radial nerve, which may help reduce the incidence of iatrogenic radial nerve injury and the intraoperative bleeding volume. In addition, it has the advantages of operability, safety, efficiency and repeatability.

A comparative study on the Efficacy of Retroperitoneoscopic Pyeloplasty and Open Surgery for Ureteropelvic Junction Obstruction in Children

Objectives: To compare the therapeutic effect of retroperitoneoscopic dismembered pyeloplasty and open ureteropelvic junction plasty on the ureteropelvic junction obstruction (UPJO) in children. Methods: After the retrospective analysis of clinical data, 78 children with ureteropelvic junction stenosis treated from January, 2012 to June, 2018 were divided into two groups: OP (open pyeloplasty) group (38 cases) and LP (laparoscopic dismembered pyeloplasty) group (40 cases) according to the surgical methods. The operation time, intraoperative bleeding volume, postoperative length of stay (LOS), postoperative complication rate, postoperative hydronephrosis improvement and other indicators were compared between the two groups. Results: All patients underwent surgery successfully, without conversion to open surgery in LP group. The incidence of postoperative urine leakage and the recovery of hydronephrosis between LP group and OP group 12 months after operation showed no statistically significant difference (P>0.05). The intraoperative bleeding volume, the incidence of postoperative retroperitoneal hematoma, and the postoperative LOS in LP group were lower than those in OP group, while the operation time was longer than that in the OP group, with statistically significant difference (P<0.05). Conclusion: Retroperitoneoscopic dismembered pyeloplasty had similar effect with open dismembered pyeloplasty, but faster recovery and fewer complications, so it has become the preferred treatment method for UPJO in children. doi: https://doi.org/10.12669/pjms.37.7.4205 How to cite this:Jia J, Meng Q, Zhang M, Qi J, Wang D. A comparative study on the Efficacy of Retroperitoneoscopic Pyeloplasty and Open Surgery for Ureteropelvic Junction Obstruction in Children. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4205 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Association between bleeding volume with heme oxygenase-1 and malondialdehyde levels in patients of acute intracerebral hemorrhage

Background: Oxidative stress plays an important role in secondary brain damage after a stroke of intracerebral hemorrhage because it causes permanent damage to grey matter, white matter taken by brain blood barrier disorders, and brain edema with brain cells. This study aimed to determine the correlation between bleeding volume and heme oxygenase-1 (HO-1) and malondialdehyde (MDA) levels in stroke patients with acute intracerebral hemorrhage at Dr. Soetomo Hospital, Surabaya.

Feasibility of Microwave-Based Scissors and Tweezers in Partial Hepatectomy: An Initial Assessment on Canine Model

Purpose: This study aimed to assess the feasibility of partial hepatectomy (PH) simplified by using microwave-based devices in animal experiments.Methods: PH was performed on 16 beagles using either Acrosurg Scissors (AS) or Acrosurg Tweezers (AT) without hepatic pedicle (HP) control. Parenchymal transection time, Glissonean pedicle (GP) seal time, bleeding volume, bile leak, and burst pressure were recorded. Probable complications were investigated after 4 weeks.Results: Transection time (6.5 [6.0–7.6] vs. 11.8 [10.5–20.2] min, p &lt; 0.001) with AT were significantly shorter than with AS. GP sealing times (60 [55–60] vs. 57 [46–91] s, p = 0.859) by both devices were nearly similar. Bleeding volume in the AT group was approximately one-fourth of that in the AS group (6.7 [1.4–22] vs. 28.8 [5.8–48] mL, p = 0.247). AT created higher burst pressure on the bile duct stumps (p = 0.0161). The two devices did not differ significantly in morbidity and mortality after four-week follow-up.Conclusion: Acrosurg devices achieved a safe PH without HP control owing to microwave-based sealing. AS could be used alone in PH, whereas the clamp-crushing function of AT seemed more advantageous in reducing the transection time and blood loss.

Retrospective analysis of massive epistaxis and pseudoaneurysms in nasopharyngeal carcinoma after radiotherapy

Objectives This article focuses on massive epistaxis and pseudoaneurysm in patients with NPC after radiotherapy and discusses clinically relevant treatment strategies. Design Retrospective the medical data of NPC patients with massive epistaxis after radiotherapy and review the English literature over the past 10 years. Setting Otorhinolaryngology department in the First Affiliated Hospital of Nanchang University. Participants 21 patients with massive epistaxis after radiotherapy for NPC. Main outcome measures Characteristics and related causes of massive epistaxis or pseudoaneurysms were analyzed in terms of the clinical stage of NPC, course of radiotherapy, and affected artery. An analysis was performed on the methods of endovascular interventional treatment of such pseudoaneurysms. Results 19 cases were accompanied with bone destruction of the skull base; 13 cases were found tumor recurrence; 15 cases were in stage III or IV of NPC; 14 cases were combined with pseudoaneurysms. Analysis with the imaging of pseudoaneurysms, we found that the petrous ICA was the most predilection site. There were 11 out of 14 pseudoaneurysms had sentinel hemorrhage in the initial phase. All 14 pseudoaneurysm patients were underwent endovascular interventional therapy, but one died from hemorrhagic shock during the procedure. There were no rebleeding again among other patients. Conclusions Pseudoaneurysm could cause massive epistaxis with high mortality. The formation of a pseudoaneurysm was closely associated with a high carcinoma stage, re-radiotherapy, and local bone destruction and infection. Most cases had sentinel epistaxis. The imaging material prompted that pseudoaneurysm had a predisposition to the petrous part of the ICA, while the preferred therapy was endovascular embolization treatment. Key poits 1.Patients with massive epistaxis mean a single nasal bleeding volume exceeded 100 ml, or cumulative bleeding volume was more than 300 ml. 2.Patients who presented with active oronasal bleeding should be rapidly managed by nasal packing. 3.When there is hemorrhagic shock, patients should undergo endotracheal intubation and blood transfusion before being transferred to the otorhinolaryngology department. 4.CTA and DSA are recommended for patients with massive epistaxis associated with NPC after radiotherapy. 5.Interventional embolization is recommended to patients with pseudoaneurysm.