Optimal Wire Myography Normalization for the Rat Dorsal Penile, Internal Pudendal and Internal Iliac Arteries

In functional arterial studies using wire myography, the determination of a vessel’s standardized normalization factor (factor k) is an essential step to ensure optimal contraction and relaxation by the arteries when stimulated with their respective vasoactive agents and to obtain reproducible results. The optimal factor k for several arteries have been determined; however, the optimal initial tension and factor k for the arteries involved in erection remains unknown. Hence, in the present study we set out to determine the optimal factor k for the internal iliac artery, proximal and distal internal pudendal artery (IPA), and dorsal penile artery. After isolating, harvesting, and mounting the arteries from male Sprague-Dawley rats on a multi wire myograph, we tested arterial responsivity to high K+-stimulation when the factor k was set at 0.7, 0.8, 0.85, 0.9, 0.95, 1.0, 1.1, and 1.2 to determine the factor k setting that results in the greatest K+-induced active force production for each vessel type. The data showed the optimal factor k is 0.90-0.95 for the dorsal penile, distal internal pudendal and internal iliac arteries while it is 0.85-0.90 for proximal internal pudendal artery. These optimal values corresponded to initial passive tension settings of 1.10±0.16 - 1.46±0.23, 1.28±0.20 - 1.69±0.34, 1.03±0.27 - 1.33±0.31, and 1.33±0.31 - 1.77±0.43 mN/mm for the dorsal penile, distal IP, proximal IP, and internal iliac arteries, respectively.

Congenital Anatomical Variant with Cranial Origin of Internal Iliac Arteries

We report the case of a 73-year-old male who underwent abdominal multidetector computed tomography with vascular reconstruction that highlighted a congenital variant of iliac arteries. Iliac artery anatomical variants are exceedingly rare and only a few cases have been reported in the literature.

Surgical hemostasis for obstetric hemorrhage: experimental and clinical studies

The article presents a review of the literature on the problems of treatment of obstetric bleeding in the light of historical development and modern opportunities. Currently existing options for surgical hemostasis: ligation of pelvic vessels, ligation of internal iliac arteries, embolization of uterine arteries and compression sutures on the uterus are considered from the perspective of experimental work and clinical research. The paper reflects the opinions of domestic and foreign scientists, which were a vector for further study and experiments.

Revisiting Role of Bilateral Ligation of Internal Iliac Arteries and Preperitoneal Pelvic Packing for Haemorrhage Control in Patients with Pelvic Injuries in Resource Constraint Settings.

Background Since the description of bilateral ligation of internal iliac arteries (BLIIA) and preperitoneal pelvic packing (PPP) for haemorrhage control in pelvic injury patients, multiple reports have been published advocating its use with acceptable outcomes. We analyzed our experience with this technique in a setting where the facility of hybrid Operating room for simultaneous angioembolisation is not available. Material and Methods We prospectively analysed data of sixty-six patients who presented in a state of unresponsive shock with pelvic fracture between January 2014 and September 2019. After initial resuscitation, they all underwent BLIIA with PPP as part of damage control surgery. Results Out of 66 patients, 55 were male. The mean age was 36.12 years. All patients sustained blunt trauma, with road traffic injuries being the most common mechanism involving 65 % of the patients followed by fall from height. The mean systolic blood pressure at the time of surgery was 77 + -34.46mm Hg. Median packed red blood cell transfusion in the first 24 hours was 8.5 units with IQR of 6-12. The hemorrhage related mortality was 48%. Conclusion BLIIA with PPP may be considered as a viable treatment option in hemodynamically unstable patients with pelvic injuries in resource constraint facilities

To clamp or not to clamp?

Introduction: Radical prostatectomy (RP) is the gold-standard surgical treatment for men with clinically localized prostate cancer (PCa). Surgical techniques to minimize intra and post-operative complications are well established, but excessive bleeding during RP continues to be a concern. The objective of our study was to determine whether additional intraoperative temporary occlusion of the internal iliac arteries combined with a penile base tourniquet during open RP improves hemostasis. Methods: We conducted a retrospective chart review of 23 patients who underwent open RP between Jan 2014 to May 2016. Eight patients underwent open RP with additional clamping of the internal iliac arteries using bulldog vascular clamps combined with a penile base penrose drain tourniquet as temporary prostatic arterial and venous control during dorsal venous complex ligation and neurovascular bundle sparing. Our primary outcome was immediate and post-operative day 1 hemoglobin levels. Our main outcome was analyzed using Students t-test with equal variance. Results: We stratified participants by clamping type. Fifteen patients underwent no clamping and 8 patients had the combined temporary clamping. Primary analysis of estimated blood loss showed a reduction in average blood loss among individuals with vascular control technique versus usual technique (516 ml and 754 ml respectively, p= 0.021). There were no obvious intraoperative or postoperative complications noted that could have been attributable to the temporary vascular control techniques. Conclusion: Temporary vascular control with the addition of minor surgical techniques during open RP may improve an objective measure of blood loss immediately after surgery.