Toxicity Outcome Using Bladder-Rectum Spacer Balloon Versus Vaginal Gauze Packing in Brachytherapy in Cervical Cancer.

BACKGROUNDTo compare the clinical impact in terms of toxicity outcomes with RayshieldTM bladder rectum spacer balloon (BRSB) versus vaginal gauze packing (VGP) in patients treated with high dose rate intracavitary brachytherapy for carcinoma cervix.RESULTSFollow-up and dosimetric data of patients in whom BRSB and VGP were used in a previously reported randomized study were retrieved, 8. Out of 80 patients analysed, late toxicities assessment (according to Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v4). was possible in 65 patients as 14 patients were lost to follow-up and one patient died. Grade 2 bladder toxicity was observed in 2 patients in each arm. Only 1 patient in VGP arm experienced grade 3 proctitis while none of the patient in BRSB arm had ³Grade 2 rectal toxicity. Vaginal toxicity was comparable in both the arms.CONCLUSION No significant difference was observed in bladder and rectal toxicities using the BRSB versus VGP. BRSB can be considered as an alternative to VGP in intracavitary brachytherapy for cervical cancer using tandem- ovoid applicatorsThe study was approved by the institute ethics committee and registered under Clinical Trial Registry of India (CTRI/2009/091/000840).

Results of blunt hepatic trauma surgery at Nghe An General Friendship Hospital

Introduction: To evaluate the results of surgical treatment of blunt hepatic trauma at Nghe An General Friendship Hospital. Materials and Methods: This was a retrospective descriptive study which included 37 patients who were diagnosed with blunt hepatic trauma and underwent surgery from January 2014 to April 2020 at Nghe An General Friendship Hospital. Results: There were 30 males (81.1%) and 7 females (21.9%). The mean age of the patients was 32.32 ± 11.053 (ranged from 7 to 57). Traffic accident accounted for 67.6% and grade IV liver injury contributed 54.6%. The selective combined with complete Glissonean pedicle management technique was carried out in 75.7% of the patients. The treatment methods included suture (32.4%), hepatectomy (48.6%), suture with gauze packing (10.8%), gauze packing only (8.1%) and gallbladder drainage (51.4%). The intra- and post-operative complications consisted of biliary fistula (2.7%), bleeding (5.4%), post-operative liver failure (2.7%), pneumonia (10.8%) and mortality (10.8%). The results were as following: Good 68.8%, Average (15.6%) and Bad (15.6%). Conclusions: Blunt hepatic trauma is an emergency surgical and with patients who do not have conservative treatment, the treatment is surgery. The timely appointment and the right method bring good results for these patients. Keywords: Blunt hepatic trauma, liver trauma; liver surgery.

Massive hemothorax due to bleeding from thoracic spinal fractures: a case series and systematic review

Background Massive hemothorax secondary to thoracic spinal fractures is rare, and its clinical characteristics, treatment, and prognosis are unknown. We present two cases of thoracic spinal fracture-induced massive hemothorax and a systematic review of previously reported cases. Methods This study included patients with traumatic hemothorax from thoracic spinal fractures at a Japanese tertiary care hospital. A systematic review of published cases was undertaken through searches in PubMed, EMBASE, and ICHUSHI from inception to October 13, 2019. Results Case 1: An 81-year-old man developed hemodynamic instability from a right hemothorax with multiple rib fractures following a pedestrian–vehicle accident; > 1500 mL blood was evacuated through the intercostal drain. Thoracotomy showed hemorrhage from a T8-burst fracture, and gauze packing was used for hemostasis. Case 2: A 64-year-old man with right hemothorax and hypotension after a fall from height had hemorrhage from a T7-burst fracture, detected on thoracotomy, which was sealed with bone wax. Hypotension recurred during transfer; re-thoracotomy showed bleeding from a T7 fracture, which was packed with bone wax and gauze for hemostasis. The systematic review identified 10 similar cases and analyzed 12 cases, including the abovementioned cases. Inferior part of thoracic spines was prone to injury and induced right-sided hemothorax. Most patients developed hemodynamic instability, and some sustained intra-transfer hemorrhage; direct compression (gauze packing, bone wax, and hemostatic agents) was the commonest hemostatic procedure. The mortality rate was 33.3%. Conclusions Hemothorax due to thoracic spinal fracture can be fatal. Thoracotomy with direct compression is necessary in hemodynamically unstable patients.

Efficacy of a Temporary Hemostatic Device in a Swine Model of Closed, Lethal Liver Injury

Introduction Solid abdominal organ hemorrhage remains one of the leading causes of death both on the battlefield of modern warfare and in the civilian setting. A novel, temporary hemostatic device combining CELOX and direct intra-abdominal physical compression was invented to control closed SAOH during transport to a medical treatment facility. Materials and Methods A swine model of closed, lethal liver injury was established to determine hemostasis. The animals were randomly divided into group A (extra-abdominal compression), group B (gauze packing), group C (intra-abdominal compression), group D (CELOX coverage), and group E (intra-abdominal compression and CELOX coverage) with six swines per group. Survival time (ST), blood loss (BL), vital signs, pathologic examination, and CT-scan were monitored to further observe the effectiveness of the device. Results Group E had an average 30-minute extension in ST (74.3 ± 15.4 minutes versus 44.0 ± 13.8 minutes, p = 0.026) with less BL (46.0 ± 13.0 versus 70.8 ± 8.2 g/kg, p = 0.018), and maintained mean arterial pressure≥70 mmHg and cardiac output ≥ 3.5 L/minute for a longer time. No significant differences were observed in ST and BL of groups B and E, and there were no marked differences in ST and BL of groups A, C, and D. No CELOX clots were noted in the spleen, pancreas, lungs, heart, kidneys, or the adjacent large vessels in groups D and E. Compared to group A, the CT-scan showed better hepatic hemorrhage control in group E. Conclusions The device, which combined 20 g of CELOX particles and 20 pieces of CELOX (8 g) sponge tablets with 50-mmHg intra-abdominal compression for 10 minutes, prolonged the ST by an average of 30 minutes with less BL. It was not markedly different from the full four quadrants gauze packing of liver in hemostatic effect, with no CELOX clot formation in other organs.