Use of Suture-Mediated Closure Devices for Closure of Punctures in Prosthetic Patches or Grafts is Associated With High Rates of Technical Success and Low Complication Rates

Objectives Despite the increasing use of endovascular techniques in the management of peripheral vascular disease, there is little data on the safety of percutaneous closure devices in punctures of synthetic vascular material. Our paper sought to address this paucity in the literature by reviewing the incidence of complications occurring in patients in whom the ProGlide device was utilised to achieve haemostasis post-percutaneous puncture of vascular patches and graft materials. Methods A retrospective review of patient records was conducted at a tertiary referral centre. Patients who had undergone percutaneous punctures of prosthetic bypass grafts or patch angioplasties between January 2011 and December 2020 were identified from a prospectively collected database. Medical records and post-procedural imaging were reviewed to assess the occurrence of post-procedural complications such as pseudoaneurysms, puncture site stenosis and further interventions for access complications. Results A total of 73 punctures of prosthetic material were performed in 42 patients, of which 39 utilised ProGlides. Median age of included patients was 72 years. There was male predominance in the cohort (69.8%), and most punctures (87.3%) were through polyurethane patches. Device success rate was 95%, and no patients required open repair. There was a low incidence of complications, with no patients developing pseudoaneurysms, arteriovenous fistulas, ischaemic limbs or > 50% stenosis when either manual pressure or the ProGlide device was used to achieve haemostasis. Furthermore, there were no returns to theatre or further interventions performed for access site complications. Conclusion The use of the ProGlide closure device has a low incidence of complications and its safety appears to be equivalent to manual compression when used to achieve haemostasis in percutaneous punctures of synthetic vascular material in select patients. To our knowledge, this is the only article to date to assess the safety of the ProGlide in this setting.

Scaphocapitate fracture syndrome in a child

BACKGROUND: Scaphocapitate fracture syndrome involves transverse fracture of the scaphoid and capitate, with rotation of 90 or 180 of the proximal fragment of the capitate, commonly associated with other carpal lesions. It is a rare wrist injury, usually occurs in young men and is exceptional in children. The exact mechanism remains controversial. The injury is often misdiagnosed as a simple scaphoid fracture and there has been a controversy about the treatment of the capitate fracture in this syndrome. CLINICAL CASE: The authors report a rare case of a scaphocapitate syndrome in a 15-year-old boy. Early open reduction of both fractures was performed. It was obtained a good mobility, with a normal grip strength and the radiographs showed union of both bones without avascular necrosis. DISCUSSION: Most authors agree that regardless of the radiographic appearance of the injury, open reduction and internal fixation is the treatment of choice. The dorsal approach is the most used. The capitate fragment is usually devoid of any soft tissues and is reduced relatively easy with manual pressure, by applying traction to the hand. Reduction and fixation of the capitate must precede that of the scaphoid. K-wires or headless screws may be placed from the proximal to the distal side for the fixation of the scaphoid and capitate. The evolution is marked by the risk of occurrence of head capitate avascular necrosis CONCLUSIONS: This case report illustrates that the scaphocapitate syndrome can occur in children and is important an early diagnosis to initiate timely treatment. Our patient was successfully treated with open reduction and fixation using K-wires.

Polymeric Materials for Hemostatic Wound Healing

Hemorrhage is one of the greatest threats to life on the battlefield, accounting for 50% of total deaths. Nearly 86% of combat deaths occur within the first 30 min after wounding. While external wound injuries can be treated mostly using visual inspection, abdominal or internal hemorrhages are more challenging to treat with regular hemostatic dressings because of deep wounds and points of injury that cannot be located properly. The need to treat trauma wounds from limbs, abdomen, liver, stomach, colon, spleen, arterial, venous, and/or parenchymal hemorrhage accompanied by severe bleeding requires an immediate solution that the first responders can apply to reduce rapid exsanguinations from external wounds, including in military operations. This necessitates the development of a unique, easy-to-use, FDA-approved hemostatic treatment that can deliver the agent in less than 30 s and stop bleeding within the first 1 to 2 min at the point of injury without application of manual pressure on the wounded area.

Comparison of two different probing systems for evaluation of bleeding on probing (BOP)

: Bleeding on probing (BOP) is the best documented parameter in the monitoring of periodontal health and inflammation of the gingival tissues. It is measured as bleeding provoked by applying a probe to the bottom of a sulcus/pocket. Since BoP may be provoked by trauma to the tissues using a periodontal probe hence, probing pressure can be considered as an important factor in the assessment of bleeding on probing. The purpose of the study was to evaluate bleeding on probing by conventional probe and pressure sensitive probe. : 50 subjects (1400 sites) in this split mouth study were evaluated for bleeding on probing by using a conventional periodontal probe and a manual pressure sensitive probe. Gingival Bleeding Index (Ainamo and Bay 1975) was used in the study for assessment of BOP. : More bleeding sites were found in the quadrant associated with the conventional probe as compared to the sites associated with pressure sensitive probe. : Amount of pressure applied during probing can be a significant factor in assessment the periodontal disease activity.

Preprocedural Hypertension Is Not a Risk Factor for Postoperative Bleeding following Image-Guided Core Needle Breast Biopsy

Objective. To evaluate the association between preprocedural hypertension and the risk of prolonged bleeding following image-guided core needle breast biopsy in nonpregnant/nonlactating women. Methods. A single institution-based, retrospective cohort study of 400 women who underwent image-guided core needle breast biopsy was conducted. Males and pregnant and lactating women were excluded. Preprocedural systolic or diastolic blood pressure greater than 140 or 90 mm of Hg, respectively, was defined as hypertension. Prolonged bleeding was defined >15 minutes of local, manual pressure required to achieve hemostasis following the biopsy. Severe bleeding complications defined as clinical significant hematoma formation, prolonged bleeding requiring an ER visit, hospitalization, or surgical intervention were also recorded. Results. The difference in the mean time for which manual pressure was held after biopsy for patients with and without preprocedural hypertension was not statistically significant (13 ± 7 vs. 13 ± 8 minutes, respectively, P = 0.856). There was no difference in the number of patients requiring manual postoperative pressure >15 minutes between those with preprocedural hypertension and the normotensive patients (13% vs. 12%, respectively, P = 0.765). Bivariate analysis demonstrated statistically significant association between prolonged bleeding and current antithrombotic or antiplatelet medication use ( P = 0.010), the use of stereotactic guidance ( P = 0.019), and a tethered vacuum-assisted device ( P = 0.045). The use of a tethered vacuum-assisted biopsy device was the only variable associated with prolonged bleeding in the multivariate model ( P = 0.044). Conclusion. Preprocedural hypertension is not a risk factor for prolonged bleeding following image-guided core needle breast biopsies in nonpregnant/nonlactating women.

Effectiveness of sarolaner in the clinical management of furuncular myiasis in dogs naturally infested with Dermatobia hominis (Diptera: Cuterebridae)

Background The human botfly, Dermatobia hominis, is a common cause of furuncular myiasis in dogs in Latin America. Lesions can be single or multiple, each harboring an individual larva, presented as an erythematous nodule that causes pruritus and pain. Typical treatment consists of sedation for removal of larvae by surgical incision or manual pressure. Medications to kill the larva before its extraction can reduce inflammation and discomfort and provide a less traumatic larval removal. Isoxazolines are broad-spectrum ectoparasiticides with larvicidal activity previously reported in the treatment of screwworm myiasis in companion animals. The aim of this study was to evaluate the effectiveness of sarolaner as part of the clinical management of furuncular myiasis in dogs caused by D. hominis larvae. Methods Ten short-haired mixed breed dogs naturally infested with D. hominis were enrolled. Clinical diagnosis was achieved by observation of skin nodules and visualization of larval motility through the lesion orifice. Sarolaner was administered at manufacturer recommended dose for fleas and ticks. Lesions were reexamined 24 h post-treatment and assessed for viability of larvae. Larvae were removed by digital compression and identified as D. hominis. Results Seventy-five D. hominis larvae were retrieved from ten dogs. No live larvae were observed, demonstrating 100% larvicidal efficacy of sarolaner. Skin lesions were healed 30 days post-treatment and new lesions were not observed. Conclusions Sarolaner seems to be effective as larvicidal treatment for dogs with furuncular myiasis, reducing discomfort caused by the presence of the larva in the skin and facilitating its safe removal. Graphical abstract

Índice de Masa Corporal, Velocidad de Marcha y Fuerza de Prensión Manual en Mujeres Mayores Chilenas (Body Mass Index, Gait Speed and Manual Pressure Force in Chilean Older Women)

Objetivo: El objetivo del presente estudio es de comparar la velocidad de marcha (VM), fuerza de tren superior (PM) y el Índice de Masa Corporal (IMC) en mujeres mayores que participan de forma regular en talleres de actividad física, según rango de edad, así como, verificar la asociación entre Edad, IMC y PM con VM en 10 metros. Metodología: Participaron voluntariamente 85 mujeres (70,1±6,9años) vinculadas al programa de talleres de adulto mayor del IND de la región de Ñuble. Las participantes fueron categorizadas según rango de edad (grupo total [GT], 60-64, 65-69, 70-74, 75-79 y 80-84 años). Se evaluó el peso corporal y la estatura para el cálculo de IMC, la fuerza de tren superior con la prueba de prensión manual (PM) en la mano dominante y la VM en 10 metros. Resultados: Los principales resultados apuntan que la VM fue significativamente inferior para el grupo de 80-84 años comparados a los grupos GT (p<0.03), 60-64 (p<0.00) y de 65-69 años (p<0.03). El grupo 70-74 años fueron significativamente más lento que el de 60-64 años (p<0.02). La relación entre VM y PM para el grupo analizado fue positiva, baja y no significativa (r=0,20, p<0.06). Por fin, la Edad y el IMC resultaron en un modelo estadísticamente significativo [F(2,82)=13,784; p<0.001; R2=0.252, EE = 0,204m/s] para predicción de la VM. Conclusión: En general, concluimos que la VM se reduce en grupos con edades mayores y que la PM no presenta la misma tendencia, además que la Edad y el IMC son predictores de VM en mujeres mayores. Abstract. The aim of this study is to compare the gait speed (VM), manual pressure force (PM) and the Body Mass Index (IMC) in older women who participate regularly in physical activity programs, according to age, as well as, to verify the association between Age, IMC and PM with MV in 10 meters. 85 older women (70.1 ± 6.9 years) from the physical activity program of the National Sports Institute of the Ñuble / Chile region voluntarily participated in the study. The participants were categorized according to age range (total group [GT], 60-64, 65-69, 70-74, 75-79 and 80-84 years). Body weight and height were evaluated for the calculation of IMC, upper body strength with the manual grip test (PM) in the dominant hand and the MV in 10 meters. Results: The main results indicate that MV was significantly lower for the 80-84 year-old group compared to the GT (p <0.03), 60-64 (p <0.00) and 65-69 years (p < 0.03). The 70-74 year group were significantly slower than the 60-64 year group (p <.024). The relationship between MV and PM for the analyzed group was positive, low and not significant (r = 0.20, p <0.06). Finally, Age and BMI resulted in a statistically significant model [F (2,82) = 13,784; p <0.001; R2 = 0.252, SE = 0.204m / s] for prediction of MV. Conclusion: In general, we conclude that MV decreased in older age groups and that PM does not present the same trend and that Age and IMC are predictors of MV in older women.

Effectiveness of Sarolaner in the Clinical Management of Furuncular Myiasis in Dogs Naturally Infested with Dermatobia Hominis (Diptera: Cuterebridae)

Background – The human botfly, Dermatobia hominis is a common cause of furuncular myiasis in dogs in Latin America. Lesions can be single or multiple, each harboring an individual larva, presented as an erythematous nodule that causes pruritus and pain. Typical treatment consists of sedation for removal of larvae by surgical incision or manual pressure. Medications to kill the larva before its extraction can reduce inflammation and discomfort, and provide a less traumatic larval removal. Isoxazolines are broad-spectrum ectoparasiticides with larvicidal activity previously reported in the treatment of screwworm myiasis in companion animals. The aim of this study was evaluate the effectiveness of sarolaner as part of the clinical management of furuncular myiasis in dogs caused by D. hominis larvae. Methods and materials – Ten short-haired mixed breed dogs naturally infested. Clinical diagnosis was achieved by observation of skin nodules and visualization of larval motility through the lesion orifice. Sarolaner was administered at manufacturer recommended dose for fleas and ticks. Lesions were reexamined 24 hours post-treatment and assessed for viability of larvae. Larvae were removed by digital compression and identified as D. hominis.Results – Seventy-five D. hominis larvae were retrieved from 10 dogs. No live larvae were observed, demonstrating 100% larvicidal efficacy of sarolaner. Skin lesions were healed 30 days post-treatment and new lesions were not observed.Conclusions – Sarolaner seems to be effective as larvicidal treatment for dogs with furuncular myiasis, reducing discomfort caused by the presence of the larva in the skin and facilitating its safe removal.