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Glade DC, Krunic AL, Owen JL. Response to Letter to the Editor for "'stacked stitch' for efficient closure of deep cutaneous defects". JAAD Int 2024; 15:32. [PMID: 38371674 PMCID: PMC10869909 DOI: 10.1016/j.jdin.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Affiliation(s)
- Daniel C. Glade
- Division of Dermatology, University of Texas Health San Antonio, San Antonio, Texas
| | - Aleksandar L. Krunic
- Department of Dermatology, Northwestern University, Chicago, Illinois
- Advocate Illinois Masonic Hospital, Chicago, Illinois
| | - Joshua L. Owen
- Division of Dermatology, University of Texas Health San Antonio, San Antonio, Texas
- Dermatology Service, Audie L. Murphy VA Medical Center, San Antonio, Texas
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2
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Kan P, Fiorella D, Dabus G, Samaniego EA, Lanzino G, Siddiqui AH, Chen H, Khalessi AA, Pereira VM, Fifi JT, Bain MD, Colby GP, Wakhloo AK, Arthur AS. ARISE I Consensus Statement on the Management of Chronic Subdural Hematoma. Stroke 2024; 55:1438-1448. [PMID: 38648281 DOI: 10.1161/strokeaha.123.044129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/10/2024] [Indexed: 04/25/2024]
Abstract
ARISE (Aneurysm/AVM/cSDH Roundtable Discussion With Industry and Stroke Experts) organized a one-and-a-half day meeting and workshop and brought together representatives from academia, industry, and government to discuss the most promising approaches to improve outcomes for patients with chronic subdural hematoma (cSDH). The emerging role of middle meningeal artery embolization in clinical practice and the design of current and potential future trials were the primary focuses of discussion. Existing evidence for imaging, indications, agents, and techniques was reviewed, and areas of priority for study and key questions surrounding the development of new and existing treatments for cSDH were identified. Multiple randomized, controlled trials have met their primary efficacy end points, providing high-level evidence that middle meningeal artery embolization is a potent adjunctive therapy to the standard (surgical and nonsurgical) management of neurologically stable cSDH patients in terms of reducing rates of disease recurrence. Pooled data analyses following the formal conclusion and publication of these trials will form a robust foundation upon which guidelines can be strengthened for cSDH treatment modalities and optimal patient selection, as well as delineate future lines of investigation.
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Affiliation(s)
- Peter Kan
- Department of Neurosurgery, The University of Texas Medical Branch, Galveston (P.K.)
| | - David Fiorella
- Department of Neurosurgery, Stony Brook University, NY (D.F.)
| | - Guilherme Dabus
- Interventional Neuroradiology and Neuroendovascular Surgery, Miami Neuroscience Institute and Miami Cardiac and Vascular Institute-Baptist Hospital, FL (G.D.)
| | - Edgar A Samaniego
- Department of Neurology, The University of Iowa Hospitals and Clinics (E.A.S.)
| | | | - Adnan H Siddiqui
- Department of Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, NY (A.H.S.)
| | - Huanwen Chen
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (H.C.)
| | - Alexander A Khalessi
- Department of Neurological Surgery, University of California, San Diego, La Jolla (A.A.K.)
| | - Vitor Mendes Pereira
- Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, University Health Network, Toronto Western Hospital, ON, Canada (V.M.P.)
| | - Johanna T Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.T.F.)
| | - Mark D Bain
- Cerebrovascular Center, Departments of Neurology and Neurosurgery, Neurological Institute, Cleveland Clinic Foundation, OH (M.D.B.)
| | - Geoffrey P Colby
- Department of Neurosurgery, University of California Los Angeles David Geffen School of Medicine (G.P.C.)
| | - Ajay K Wakhloo
- Department of Interventional Neuroradiology, Lahey Hospital & Medical Center, Burlington, MA (A.K.W.)
| | - Adam S Arthur
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis (A.S.A.)
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Yang J, Xiao L, Zhang L, Luo G, Ma Y, Wang X, Zhang Y. Platelets: A Potential Factor that Offers Strategies for Promoting Bone Regeneration. Tissue Eng Part B Rev 2024. [PMID: 38482796 DOI: 10.1089/ten.teb.2024.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Bone defects represent a prevalent category of clinical injuries, causing significant pain and escalating health care burdens. Effectively addressing bone defects is thus of paramount importance. Platelets, formed from megakaryocyte lysis, have emerged as pivotal players in bone tissue repair, inflammatory responses, and angiogenesis. Their intracellular storage of various growth factors, cytokines, and membrane protein receptors contributes to these crucial functions. This article provides a comprehensive overview of platelets' roles in hematoma structure, inflammatory responses, and angiogenesis throughout the process of fracture healing. Beyond their application in conjunction with artificial bone substitute materials for treating bone defects, we propose the potential future use of anticoagulants such as heparin in combination with these materials to regulate platelet number and function, thereby promoting bone healing. Ultimately, we contemplate whether manipulating platelet function to modulate bone healing could offer innovative ideas and directions for the clinical treatment of bone defects.
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Affiliation(s)
- Jingjing Yang
- Department of Hygiene Toxicology, School of Public Health, Zunyi Medical University, Zunyi, China
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Key Laboratory of Maternal and Child Health and Exposure Science of Guizhou Higher Education Institutes, Zunyi Medical University, Zunyi, China
- Guizhou Provincial Key Laboratory of Medicinal Biotechnology in Colleges and Universities, Zunyi Medical University, Zunyi, China
| | - Lan Xiao
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- School of Medicine and Dentistry, Griffith University, Queensland, Australia
| | - Lijia Zhang
- Department of Hygiene Toxicology, School of Public Health, Zunyi Medical University, Zunyi, China
- Key Laboratory of Maternal and Child Health and Exposure Science of Guizhou Higher Education Institutes, Zunyi Medical University, Zunyi, China
| | - Guochen Luo
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yaping Ma
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xin Wang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Guizhou Provincial Key Laboratory of Medicinal Biotechnology in Colleges and Universities, Zunyi Medical University, Zunyi, China
| | - Yi Zhang
- Department of Hygiene Toxicology, School of Public Health, Zunyi Medical University, Zunyi, China
- Key Laboratory of Maternal and Child Health and Exposure Science of Guizhou Higher Education Institutes, Zunyi Medical University, Zunyi, China
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4
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Pena Prado A, Caron A. [Implementing vascular access protection indicators (VAPI) in dialysis: an innovation in quality of care]. Rev Infirm 2024; 73:30-33. [PMID: 38643999 DOI: 10.1016/j.revinf.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Between 2013 and 2021, indicators of vascular access protection (IPAV) integrating a census of haematomas and multiple punctures were set up on the active file of chronic kidney failure patients with a vascular access dialyzed in Monaco's private haemodialysis center. They could help reduce the occurrence of complications and improve the quality of care offered to patients. This article reports on the results obtained before and after the introduction of this quality approach.
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Affiliation(s)
- Angeline Pena Prado
- Centre d'hémodialyse privé de Monaco, Elsan, 32-34 quai Jean-Charles-Rey, 98000 Monaco.
| | - Alexandre Caron
- Cemka, 43 boulevard du Maréchal-Joffre, 92340 Bourg-la-Reine, France
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5
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Cicia M, Papi G, Scillitani A, Corrado S, Locantore P, Pontecorvi A. Cervicomediastinal Hematoma: Atypical Presentation of a Parathyroid Carcinoma. JCEM Case Rep 2024; 2:luae063. [PMID: 38638336 PMCID: PMC11025637 DOI: 10.1210/jcemcr/luae063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Indexed: 04/20/2024]
Abstract
Parathyroid carcinoma (PC) is a rare endocrine neoplasm that typically presents with osteopenia/osteoporosis, nephrolithiasis, asthenia, and neuropsychiatric symptoms. We describe the case of a 48-year-old woman, presenting with a large painful hematoma in the cervicomediastinal area. The neck ultrasound (US) demonstrated a solid lesion measuring 40 × 80 × 55 mm, markedly hypoechoic, which extended from the right thyroid lobe to the mediastinum. The blood tests showed elevated serum calcium and parathyroid hormone (PTH) concentrations, consistent with hypercalcemic primary hyperparathyroidism. The patient was rehydrated and treated with furosemide, cholecalciferol, and bisphosphonate, and underwent right lower parathyroidectomy, right hemithyroidectomy, and lymphadenectomy of the right VI cervical level. Histological examination was diagnostic for nonangioinvasive or neuroinvasive PC, and the thyroid lobe was the site of lymphocytic thyroiditis; all removed lymph nodes were benign. The postoperative course was regular. Postoperative neck US showed a hypoechoic left thyroid lobe without evidence of residual neoplasm in the right thyroid bed. Levothyroxine therapy of 50 mcg/day was started because of serum thyrotropin concentrations elevated at 18 mcIU/mL (normal reference range, 0.35-4.0 mIU/mL). Eight years after diagnosis, the patient is in good general condition, with no clinical, biochemical, or imaging evidence of disease persistence/recurrence.
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Affiliation(s)
- Martina Cicia
- Unit of Endocrinology, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Fondazione Policlinico “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Giampaolo Papi
- Endocrinology Unit, Azienda USL Modena, 41121 Modena, Italy
| | - Alfredo Scillitani
- Endocrinology Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo (FG), Italy
| | - Stefania Corrado
- Pathology Unit, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Pietro Locantore
- Unit of Endocrinology, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Fondazione Policlinico “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Alfredo Pontecorvi
- Unit of Endocrinology, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Fondazione Policlinico “A. Gemelli” IRCCS, 00168 Rome, Italy
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6
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Hassan A, Habbash Z, Aljawad M, Alnemer F, Alzayer A, AlZaher A. Warfarin Woes: A Rare Case of Hemoperitoneum with Intramural Small Bowel Hematoma. Am J Case Rep 2024; 25:e943519. [PMID: 38556771 PMCID: PMC11000204 DOI: 10.12659/ajcr.943519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/13/2024] [Accepted: 02/09/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Small bowel hematoma is a rare yet clinically significant condition characterized by the accumulation of blood within the mucosa and submucosa layers of the small intestine wall. It can lead to complications such as bowel obstruction, ischemia, perforation, and even hemorrhagic shock. The etiology of intramural small bowel hematoma is diverse, encompassing factors such as anticoagulant therapy, coagulopathies, vascular disorders, trauma, and underlying systemic conditions. CASE REPORT We present the case of a 67-year-old man with a history of aortic valve replacement who presented with intense abdominal pain. Physical examination revealed generalized abdominal tenderness and black stools upon rectal examination. Laboratory tests indicated coagulopathy with a prolonged thrombin time. A computed tomography scan confirmed the presence of an intramural small bowel hematoma and hemoperitoneum. The patient's condition significantly improved within 48 h under conservative management, including nasogastric tube insertion, continuous monitoring of gastric aspirate, nil per os status, intravenous fluids, and analgesics. Warfarin was temporarily stopped, and fresh frozen plasma was administered for anticoagulation reversal. Heparin infusion was initiated once the INR became within the therapeutic level. CONCLUSIONS The occurrence of spontaneous intramural small bowel hematoma, although rare, demands rapid diagnosis and prompt, well-coordinated management. This case underscores the pivotal role of multidisciplinary collaboration in providing a comprehensive assessment and a tailored approach to treatment. While conservative measures, including careful monitoring and supportive care, have demonstrated favorable outcomes, the consideration of surgical intervention remains crucial, particularly in severe cases.
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Affiliation(s)
- Ali Hassan
- Department of Radiology, Salmaniya Medical Complex, Manama, Bahrain
| | - Zainab Habbash
- Department of Radiology, Salmaniya Medical Complex, Manama, Bahrain
| | - Mahdi Aljawad
- Department of Radiology, Maternity and Children Hospital, Dammam, Saudi Arabia
| | - Faris Alnemer
- Department of Radiology, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Ali Alzayer
- Department of Radiology, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Aqil AlZaher
- Department of Radiology, Qatif Central Hospital, Qatif, Saudi Arabia
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Ganesh A, Testai FD. Remote Ischemic Conditioning for Acute Ischemic Stroke: Does Stroke Etiology Matter? Stroke 2024; 55:880-882. [PMID: 38527151 DOI: 10.1161/strokeaha.124.046615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Affiliation(s)
- Aravind Ganesh
- Calgary Stroke Program, Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, the Matheson Centre for Mental Health Research and Education, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Alberta, Canada (A.G.)
| | - Fernando D Testai
- Department of Neurology and Rehabilitation, University of Illinois Chicago (F.D.T.)
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Jiao Y, Ceccato GHW, Borba LAB, Han H. CRANIOPLASTY WITH DIRECT REVASCULARIZATION IN HEMORRHAGIC MOYAMOYA DISEASE: 2-DIMENSIONAL OPERATIVE VIDEO. World Neurosurg 2024:S1878-8750(24)00354-1. [PMID: 38453006 DOI: 10.1016/j.wneu.2024.02.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/26/2024] [Indexed: 03/09/2024]
Abstract
Moyamoya disease is a progressive nonatherosclerotic stenosis of the terminal segments of the arteries of the Circle of Willis. Hemorrhagic presentation is a life-threatening condition, associated with an increased risk of rebleeding and ischemic events.1-7 We present the case of a 65-year-old woman with a right intracerebral hemorrhage who underwent emergency hematoma evacuation without bone flap replacement. The investigation confirmed the diagnosis of Moyamoya disease and demonstrated hypoperfusion of the right cerebral hemisphere. Late angiography depicted no transdural collaterals through the bone defect and demonstrated preservation of the superficial temporal artery (STA). Next, it was chosen to perform one-stage cranioplasty with direct revascularization. We detached the temporal fascia from the muscle and created a window through the fascia to give STA passage in a corridor through the temporal muscle until the brain's surface. Vascular anastomosis was performed with an interrupted suture line employing a 10-0 nylon thread. Flow within the right middle cerebral artery (MCA) was retrograde, coming from branches of the posterior cerebral artery (PCA), and the end-to-side anastomosis was placed to orientate the STA flow in the same direction as in the MCA. We used a custom-made titanium plate for the cranioplasty and gave enough room inferiorly for the course of STA. In the end, we sutured the temporal fascia to the titanium plate for a better cosmetic result. To avoid additional unnecessary procedures, the performance of direct revascularization during the cranioplasty is feasible and deserves additional investigation as a tool to prevent new hemorrhagic or ischemic events. Informed consent was obtained from the patient for the procedure and publication of this operative video.
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Affiliation(s)
- Yonghui Jiao
- Department of Neurosurgery, Aviation General Hospital, Beijing, China
| | - Guilherme H W Ceccato
- Department of Neurosurgery, Mackenzie Evangelical University Hospital, Curitiba, PR, Brazil; Department of Neurosurgery, Rehabilitation Hospital Center Ana Carolina Moura Xavier, Curitiba, PR, Brazil
| | - Luis A B Borba
- Department of Neurosurgery, Mackenzie Evangelical University Hospital, Curitiba, PR, Brazil; Department of Neurosurgery, Rehabilitation Hospital Center Ana Carolina Moura Xavier, Curitiba, PR, Brazil
| | - Hongyan Han
- Department of Neurosurgery, Aviation General Hospital, Beijing, China.
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Chen H, Colasurdo M, Kan PT. Middle meningeal artery embolization as standalone treatment versus combined with surgical evacuation for chronic subdural hematomas: systematic review and meta-analysis. J Neurosurg 2024; 140:819-825. [PMID: 37877965 DOI: 10.3171/2023.7.jns231262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/20/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVE Middle meningeal artery embolization (MMAE) is a novel treatment for chronic subdural hematomas (cSDHs) with high variability of use across practitioners and institutions. This study sought to investigate whether standalone MMAE may be an effective alternative to combined MMAE and surgery for select patients with cSDH. METHODS The authors searched the Medline and Embase databases for studies reporting outcomes specific to standalone MMAE and combined MMAE and surgery. The Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool was used to assess risk of bias in each included study. Patient characteristics were compared between cohorts, and rates of surgical recurrence of standalone MMAE and combined MMAE and surgery were pooled using random-effects models. RESULTS Four hundred two unique patients (156 with standalone MMAE and 246 with combined MMAE and surgery) were identified across 8 studies. Overall, the subdural thickness for the standalone MMAE group was modestly but statistically significantly smaller (16.8 vs 18.8 mm, estimated p value 0.002), and the mean follow-up time was significantly longer for the standalone MMAE group (5.4 vs 2.3 months, estimated p value < 0.001); there were no significant differences between age, sex, and anticoagulant use. The surgical recurrence rates were not significantly different between the two groups (estimated p value 0.63). Using random-effects models, the surgical recurrence rates were estimated at 6.8% (95% CI 3.5%-11.2%) and 4.6% (95% CI 2.3%-7.7%) for standalone MMAE and combined MMAE and surgery, respectively. CONCLUSIONS Standalone MMAE for cSDH may yield a low rate of surgical recurrence, which may be comparable to that of combined MMAE and surgery. However, studies in this systematic review and meta-analysis were primarily single-arm studies prone to treatment bias. Future studies are needed to further investigate whether standalone MMAE may be an effective alternative to combined MMAE and surgical treatment for cSDH in select patients.
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Affiliation(s)
- Huanwen Chen
- 1National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
- 2Department of Neurology, MedStar Georgetown University Hospital, Washington, DC
| | - Marco Colasurdo
- 3Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; and
| | - Peter T Kan
- 4Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas
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Harris W, Kaiser JH, Liao V, Avadhani R, Iadecola C, Falcone GJ, Sheth KN, Qureshi AI, Goldstein JN, Awad I, Hanley DF, Kamel H, Ziai WC, Murthy SB. Association Between Hematoma Volume and Risk of Subsequent Ischemic Stroke: A MISTIE III and ATACH-2 Analysis. Stroke 2024; 55:541-547. [PMID: 38299346 PMCID: PMC10932908 DOI: 10.1161/strokeaha.123.045859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/17/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Nontraumatic intracerebral hemorrhage (ICH) is independently associated with a long-term increased risk of major arterial ischemic events. While the relationship between ICH location and ischemic risk has been studied, whether hematoma volume influences this risk is poorly understood. METHODS We pooled individual patient data from the MISTIE III (Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation Phase 3) and the ATACH-2 (Antihypertensive Treatment of Acute Cerebral Hemorrhage-2) trials. The exposure was hematoma volume, treated as a continuous measure in the primary analysis, and dichotomized by the median in the secondary analyses. The outcome was a symptomatic, clinically overt ischemic stroke, adjudicated centrally within each trial. We evaluated the association between hematoma volume and the risk of an ischemic stroke using Cox regression analyses after adjustment for demographics, vascular comorbidities, and ICH characteristics. RESULTS Of 1470 patients with ICH, the mean age was 61.7 (SD, 12.8) years, and 574 (38.3%) were female. The median hematoma volume was 17.3 mL (interquartile range, 7.2-35.7). During a median follow-up of 107 days (interquartile range, 91-140), a total of 30 ischemic strokes occurred, of which 22 were in patients with a median ICH volume of ≥17.3 mL and a cumulative incidence of 4.6% (95% CI, 3.1-7.1). Among patients with a median ICH volume <17.3 mL, there were 8 ischemic strokes with a cumulative incidence of 3.1% (95% CI, 1.7-6.0). In primary analyses using adjusted Cox regression models, ICH volume was associated with an increased risk of ischemic stroke (hazard ratio, 1.02 per mL increase [95% CI, 1.01-1.04]). In secondary analyses, ICH volume of ≥17.3 mL was associated with an increased risk of ischemic stroke (hazard ratio, 2.5 [95% CI, 1.1-7.2]), compared with those with an ICH volume <17.3 mL. CONCLUSIONS In a heterogeneous cohort of patients with ICH, initial hematoma volume was associated with a heightened short-term risk of ischemic stroke.
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Affiliation(s)
- William Harris
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Jed H. Kaiser
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Vanessa Liao
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Radhika Avadhani
- Brain Injury Outcomes Center, Johns Hopkins University, Baltimore, MD
| | - Costantino Iadecola
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Guido J. Falcone
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT
| | - Kevin N. Sheth
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT
| | - Adnan I. Qureshi
- Zeenat Qureshi Stroke Institutes and Department of Neurology, University of Missouri, Columbia, MO
| | - Joshua N. Goldstein
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Issam Awad
- Department of Neurological Surgery, University of Chicago, IL
| | - Daniel F. Hanley
- Brain Injury Outcomes Center, Johns Hopkins University, Baltimore, MD
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Wendy C. Ziai
- Brain Injury Outcomes Center, Johns Hopkins University, Baltimore, MD
- Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Santosh B. Murthy
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
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11
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Kang SH, Ahn IY, Kim HK, Kim WJ, Woo SH, Kang SH, Hong SA, Bae TH. A Rare Atypical Case of Asymptomatic and Spontaneous Intraneural Hematoma of Sural Nerve: A Case Report and Literature Review. Arch Plast Surg 2024; 51:208-211. [PMID: 38596157 PMCID: PMC11001446 DOI: 10.1055/a-2218-8461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/24/2023] [Indexed: 04/11/2024] Open
Abstract
Intraneural hematoma is a rare disease that results in an impaired nerve function because of bleeding around the peripheral nerve, with only 20 cases reported. Trauma, neoplasm, and bleeding disorders are known factors for intraneural hematoma. However, here we report atypical features of asymptomatic and spontaneous intraneural hematoma which are difficult to diagnose. A 60-year-old woman visited our clinic with the complaint of a palpable mass on the right calf. She reported no medical history or trauma to the right calf and laboratory findings showed normal coagulopathy. Ultrasonography was performed, which indicated hematoma near saphenous vein and sural nerve or neurogenic tumor. We performed surgical exploration and intraneural hematoma was confirmed on sural nerve. Meticulous paraneuriotomy and evacuation was performed without nerve injury. Histological examination revealed intraneural hematoma with a vascular wall. No neurologic symptoms were observed. In literature review, we acknowledge that understanding anatomy of nerve, using ultrasonography as a diagnostic tool and surgical decompression is key for intraneural hematoma. Our case report may help establish the implications of diagnosis and treatment. Also, we suggested surgical treatment is necessary even in cases that do not present symptoms because neurological symptoms and associated symptoms may occur later.
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Affiliation(s)
- Shin Hyuk Kang
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Dongjak-Gu, Seoul, Republic of Korea
| | - Il Young Ahn
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Dongjak-Gu, Seoul, Republic of Korea
| | - Han Koo Kim
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Dongjak-Gu, Seoul, Republic of Korea
| | - Woo Ju Kim
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong-si, Gyeonggi-do, Republic of Korea
| | - Soo Hyun Woo
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Dongjak-Gu, Seoul, Republic of Korea
| | - Seung Hyun Kang
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Dongjak-Gu, Seoul, Republic of Korea
| | - Soon Auck Hong
- Department of Pathology, Chung-Ang University Hospital, Dongjak-Gu, Seoul, Republic of Korea
| | - Tae Hui Bae
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong-si, Gyeonggi-do, Republic of Korea
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Al F, Köroglu M, Özdeş HU, Aslantürk O. Iliacus hematoma causing late femoral nerve palsy. Clin Case Rep 2024; 12:e8654. [PMID: 38464580 PMCID: PMC10920301 DOI: 10.1002/ccr3.8654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/07/2024] [Accepted: 02/28/2024] [Indexed: 03/12/2024] Open
Abstract
Femoral nerve palsy is rare and may progress insidiously, leading to late clinical presentation. Identifying the underlying cause is very important for treatment. An iliacus hematoma causing nerve palsy is perhaps the most innocent etiology. However, this hematoma sometimes causes only abdominal pain and may even be misdiagnosed as a late intra-abdominal pathology.
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Affiliation(s)
- Fırat Al
- Department of Orthopedics and TraumatologyInonu University Faculty of MedicineMalatyaTurkey
| | - Muhammed Köroglu
- Department of Orthopedics and TraumatologyInonu University Faculty of MedicineMalatyaTurkey
| | - Hüseyin Utku Özdeş
- Yesilyurt Hasan Çalık State Hospital Orthopedics and TraumatologyMalatyaTurkey
| | - Okan Aslantürk
- Department of Orthopedics and TraumatologyInonu University Faculty of MedicineMalatyaTurkey
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13
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Keulimzhayev N M, Zhanbyrbekuly U ZU, Mukhambetov Ye Z. [Clinical case of penile fracture]. Urologiia 2024:96-99. [PMID: 38650413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
A clinical case of a penile fracture as a result of an unsuccessful sexual intercourse, which later required surgical treatment in the form of corporoplasty with opening and draining of the hematoma, is discussed in the article. Penile fracture is a rare urological emergency that requires immediate medical attention to avoid long-term complications, including penile curvature and erectile dysfunction.
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Affiliation(s)
- M Keulimzhayev N
- Department of Urology and Andrology, Astana Medical University, Astana, Republic of Kazakhstan
| | | | - Zh Mukhambetov Ye
- Department of Urology and Andrology, Astana Medical University, Astana, Republic of Kazakhstan
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14
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Wang X, Yang J, Moullaali TJ, Sandset EC, Woodhouse LJ, Law ZK, Arima H, Butcher KS, Delcourt C, Edwards L, Gupta S, Jiang W, Koch S, Potter J, Qureshi AI, Robinson TG, Al-Shahi Salman R, Saver JL, Sprigg N, Wardlaw J, Anderson CS, Sakamoto Y, Bath PM, Chalmers J. Influence of Time to Achieve Target Systolic Blood Pressure on Outcome After Intracerebral Hemorrhage: The Blood Pressure in Acute Stroke Collaboration. Stroke 2024. [PMID: 38410986 DOI: 10.1161/strokeaha.123.044358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/17/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE To investigate whether an earlier time to achieving and maintaining systolic blood pressure (SBP) at 120 to 140 mm Hg is associated with favorable outcomes in a cohort of patients with acute intracerebral hemorrhage. METHODS We pooled individual patient data from randomized controlled trials registered in the Blood Pressure in Acute Stroke Collaboration. Time was defined as time form symptom onset plus the time (hour) to first achieve and subsequently maintain SBP at 120 to 140 mm Hg over 24 hours. The primary outcome was functional status measured by the modified Rankin Scale at 90 to 180 days. A generalized linear mixed models was used, with adjustment for covariables and trial as a random effect. RESULTS A total of 5761 patients (mean age, 64.0 [SD, 13.0], 2120 [36.8%] females) were included in analyses. Earlier SBP control was associated with better functional outcomes (modified Rankin Scale score, 3-6; odds ratio, 0.98 [95% CI, 0.97-0.99]) and a significant lower risk of hematoma expansion (0.98, 0.96-1.00). This association was stronger in patients with bigger baseline hematoma volume (>10 mL) compared with those with baseline hematoma volume ≤10 mL (0.006 for interaction). Earlier SBP control was not associated with cardiac or renal adverse events. CONCLUSIONS Our study confirms a clear time relation between early versus later SBP control (120-140 mm Hg) and outcomes in the one-third of patients with intracerebral hemorrhage who attained sustained SBP levels within this range. These data provide further support for the value of early recognition, rapid transport, and prompt initiation of treatment of patients with intracerebral hemorrhage.
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Affiliation(s)
- Xia Wang
- Faculty of Medicine, George Institute for Global Health, University of New South Wales, Australia. (X.W., T.J.M., C.D., C.S.A., J.C.)
| | - Jie Yang
- Department of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu (J.Y.)
| | - Tom J Moullaali
- Faculty of Medicine, George Institute for Global Health, University of New South Wales, Australia. (X.W., T.J.M., C.D., C.S.A., J.C.)
- Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (T.J.M., R.A.-S.S., J.W.)
| | - Else Charlotte Sandset
- Department of Neurology, Oslo University Hospital, Norway (E.C.S.)
- Research and Development Department, The Norwegian Air Ambulance Foundation, Oslo, Norway (E.C.S.)
| | - Lisa J Woodhouse
- Stroke Trials Unit, University of Nottingham, Queen's Medical Centre, United Kingdom (L.J.W., Z.K.L., N.S., P.M.B.)
| | - Zhe Kang Law
- Stroke Trials Unit, University of Nottingham, Queen's Medical Centre, United Kingdom (L.J.W., Z.K.L., N.S., P.M.B.)
- Stroke, Nottingham University Hospitals NHS Trust, United Kingdom (Z.K.L., N.S., P.M.B.)
- Neurology Unit, Department of Medicine, National University of Malaysia, Kuala Lumpur (Z.K.L.)
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Fukuoka University, Japan (H.A.)
| | - Kenneth S Butcher
- School of Clinical Medicine, University of New South Wales, Australia. (K.S.B.)
- Division of Neurology, University of Alberta, Edmonton, Canada (K.S.B.)
| | - Candice Delcourt
- Faculty of Medicine, George Institute for Global Health, University of New South Wales, Australia. (X.W., T.J.M., C.D., C.S.A., J.C.)
- Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia (C.D., C.S.A.)
| | - Leon Edwards
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, Australia (L.E.)
| | - Salil Gupta
- Department of Neurology, Army Hospital Research and Referral, New Delhi, India (S.G.)
| | - Wen Jiang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China (W.J.)
- The Shaanxi Cerebrovascular Disease Clinical Research Center, Xi'an, China (W.J.)
| | - Sebastian Koch
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States (S.K.)
| | - John Potter
- Stroke Research Group, Norfolk and Norwich University Hospital, United Kingdom (J.P.)
- Norwich Medical School, University of East Anglia, UK (J.P.)
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Thompson G Robinson
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, United Kingdom (T.G.R.)
| | - Rustam Al-Shahi Salman
- Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (T.J.M., R.A.-S.S., J.W.)
| | - Jeffrey L Saver
- Department of Neurology and Comprehensive Stroke Center, UCLA, Los Angeles (J.L.S.)
| | - Nikola Sprigg
- Stroke Trials Unit, University of Nottingham, Queen's Medical Centre, United Kingdom (L.J.W., Z.K.L., N.S., P.M.B.)
- Stroke, Nottingham University Hospitals NHS Trust, United Kingdom (Z.K.L., N.S., P.M.B.)
| | - Joanna Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (T.J.M., R.A.-S.S., J.W.)
| | - Craig S Anderson
- Faculty of Medicine, George Institute for Global Health, University of New South Wales, Australia. (X.W., T.J.M., C.D., C.S.A., J.C.)
- Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia (C.D., C.S.A.)
- The George Institute China, Beijing (C.S.A.)
| | - Yuki Sakamoto
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (Y.S.)
| | - Philip M Bath
- Stroke Trials Unit, University of Nottingham, Queen's Medical Centre, United Kingdom (L.J.W., Z.K.L., N.S., P.M.B.)
- Stroke, Nottingham University Hospitals NHS Trust, United Kingdom (Z.K.L., N.S., P.M.B.)
| | - John Chalmers
- Faculty of Medicine, George Institute for Global Health, University of New South Wales, Australia. (X.W., T.J.M., C.D., C.S.A., J.C.)
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15
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Paalvast Y, Díaz Padilla N, Bruijns S, Wiersum-Osselton J, Molenaar T. Donor complication rates in whole blood, plasma and platelet donors: Age versus experience. Transfusion 2024. [PMID: 38385649 DOI: 10.1111/trf.17759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/25/2024] [Accepted: 01/27/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Many blood banks use upper age limits for donors out of concern for a higher donor complication rate in older donors. Experienced donors are known to have lower donor complication rates, and older donors are often more experienced, confounding the effect of age on donor complication rate. STUDY DESIGN AND METHODS We studied donor complication rates in whole blood, plasma, and plateletpheresis donors from 2012 to 2022. Donor complication rates were compared between age groups in inexperienced (<20th donation) and experienced (≥20th donation) donors. In addition to this direct comparison, we made use of logistic regression with finer-grained experience groups, to further quantify the effects of age, experience and other factors on donor complication rate. RESULTS While overall rate of vasovagal reaction was lower, rate of moderate/severe vasovagal syncope was highest in 70-79 year donors, however, only reached significance for plasma donors. Furthermore, rates of failed stab were highest in this age group. Hematoma rate showed a U-shaped pattern with regard to age, where the rate was not higher in the 70-79 year age group than in the 18-23 year age group. Pain decreased with age, however, rates were higher in the 70-79 year age group than in the 65-69 year age group. DISCUSSION When properly accounting for donor experience, donor complication rate profiles clearly change with age. The increased risk for moderate/severe vasovagal syncope in older donors should be clearly communicated. Extra caution is needed if these donors are accepted for first-time donations.
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Affiliation(s)
- Yared Paalvast
- Donor Medicine, Sanquin Blood Bank, Amsterdam, the Netherlands
| | | | - Sanne Bruijns
- Donor Medicine, Sanquin Blood Bank, Amsterdam, the Netherlands
| | | | - Ties Molenaar
- Donor Medicine, Sanquin Blood Bank, Amsterdam, the Netherlands
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16
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Gönen T, Usgu S, Yakut Y, Akbayram S. Evaluation of the Viscoelastic Properties of Lower-Extremity Muscles of Pediatric Hemophilia Patients Using Myotonometric Measurements. Children (Basel) 2024; 11:229. [PMID: 38397341 PMCID: PMC10887738 DOI: 10.3390/children11020229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/31/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024]
Abstract
This study aimed to evaluate the viscoelastic properties of lower-extremity muscles in pediatric hemophilia (FVIII-IX) patients. The study included 20 severe- and moderate-type right-dominant hemophilia patients diagnosed with hemophilia A-B and 20 healthy children. Viscoelastic properties (tone, stiffness, elasticity) of the lower-extremity muscles were measured using a MyotonPRO device. The physical characteristics of the pediatric hemophilia patients (mean age: 11.9 ± 3.95 years) and the control group (mean age: 12.6 ± 3.41 years) were found to be similar. A difference was observed only in the elasticity of the right vastus lateralis (p < 0.05) by means of the viscoelastic properties of the lower-extremity muscles. The results were similar in other muscle groups (p > 0.05). The dominant-side vastus lateralis muscle elasticity (the ability of the muscle to regain its original shape after contraction or removal of an external force) of hemophilia patients was found to be lower compared to healthy children. The fact that 45% of hemarthroses occur in the knee joint and that recurrent bleeding may affect the flexibility of the vastus lateralis, which is the main muscle within the quadriceps muscle group and responsible for the stabilization of the patella, can be associated with the study results.
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Affiliation(s)
- Tuğba Gönen
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Hasan Kalyoncu University, Gaziantep 27000, Turkey; (T.G.); (Y.Y.)
| | - Serkan Usgu
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Hasan Kalyoncu University, Gaziantep 27000, Turkey; (T.G.); (Y.Y.)
| | - Yavuz Yakut
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Hasan Kalyoncu University, Gaziantep 27000, Turkey; (T.G.); (Y.Y.)
| | - Sinan Akbayram
- Department of Pediatric Hematology-Oncology, Faculty of Medicine, Gaziantep University, Gaziantep 27310, Turkey;
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17
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Liotta EM, Maas MB, Prabhakaran S, Shkirkova K, Sanossian N, Liebeskind DS, Sharma L, Stratton S, Conwit R, Saver JL. Magnesium and Hematoma Expansion in Intracerebral Hemorrhage: A FAST-MAG Randomized Trial Analysis. Stroke 2024; 55:463-466. [PMID: 38126183 PMCID: PMC10872280 DOI: 10.1161/strokeaha.123.043555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Observational studies suggest that magnesium may have hemostatic effects. FAST-MAG (Field Administration of Stroke Therapy-Magnesium) was a pragmatic clinical trial of magnesium sulfate administered prehospital for acute clinical stroke syndromes and included patients with intracerebral hemorrhage. Exploratory secondary analysis by the treatment group found no reduction in hematoma expansion (HE) associated with magnesium treatment in intracerebral hemorrhage but did not consider serum magnesium levels achieved. We analyzed FAST-MAG intracerebral hemorrhage data for associations between serum magnesium level, HE, and early neurological deterioration, accounting for groupwise biases. METHODS HE was defined as hematoma volume increase ≥3 mL within 24 hours and early neurological deterioration as ≥1-point Glasgow Coma Scale decline from arrival to hospital day 4. Comparing treatment and placebo groups confirmed biased availability of neuroimaging data. Therefore, HE and neurological deterioration were analyzed and stratified by treatment and placebo groups using univariate tests and adjusted logistic regression. RESULTS Spontaneous intracerebral hemorrhage was present in 381 patients. Placebo patients had fewer serial neuroimaging studies available (123 [65.4%] versus 145 [75.1%]; P=0.038). Necessary data were available in 104 magnesium- and 85 placebo-treated patients (age, 64.9 [13.0] years; 67.7% male). In the magnesium group, higher magnesium level was associated with less HE (adjusted odds ratio, 0.64 per mg/dL [95% CI, 0.42-0.93]) and less neurological deterioration (adjusted odds ratio, 0.54 per mg/dL [95% CI, 0.33-0.82]). In the placebo group, magnesium level was not associated with either HE or neurological deterioration. CONCLUSIONS Magnesium may exhibit a hemostatic effect that was only observable in the FAST-MAG magnesium treatment group. Equipoise should be maintained, and specific trials are needed. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT00059332.
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Affiliation(s)
- Eric M. Liotta
- Department of Neurology, Northwestern University, Chicago IL
| | - Matthew B. Maas
- Department of Neurology, Northwestern University, Chicago IL
| | | | | | - Nerses Sanossian
- Department of Neurology, University of Southern California, Los Angeles, CA
| | | | - Latisha Sharma
- Department of Neurology, University of California, Los Angeles, CA
| | - Samuel Stratton
- Department of Neurology, University of California, Los Angeles, CA
| | - Robin Conwit
- National Institutes of Neurological Diseases and Stroke, Bethesda, MD
- Department of Neurology, Indiana University, Indianapolis, IN
| | - Jeffrey L Saver
- Department of Neurology, University of California, Los Angeles, CA
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18
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Chi KW, Wu EB. Extraplaque blood withdrawal stenting: A miraculous cure for subintimal hematoma. J Invasive Cardiol 2024; 36. [PMID: 38335511 DOI: 10.25270/jic/23.00175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
We report the Extraplaque Blood Withdrawal stenting technique to treat chronic total occlusion percutaneous coronary intervention (CTO PCI)-induced extraplaque hematoma.
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Affiliation(s)
- Ken Wk Chi
- Prince of Wales Hospital, Chinese University Hong Kong, Hong Kong
| | - Eugene B Wu
- Prince of Wales Hospital, Chinese University Hong Kong, Hong Kong.
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19
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Khassoui AE, Attibbi M, Touraif M, Aghoutane EM, Salama T, Fezzazi RE. An Uncommon Presentation of Osteosarcoma in a Child: A Case Report. J Orthop Case Rep 2024; 14:44-47. [PMID: 38292089 PMCID: PMC10823806 DOI: 10.13107/jocr.2024.v14.i01.4142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/26/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Osteosarcoma is the most common primary malignant bone tumor in childhood distinguished by its clinical aspects, epidemiological features, and radiological and histological findings. Around 10% of patients present with distant metastasis at the most frequent sites, which are lungs and bone. Furthermore, death rates for osteosarcoma have been declining by about 1.3% per year. Case Report We report the case of a 12-year-old child who presented to the emergency department with a large thigh hematoma, and after running all the necessary clinical investigations, it turned out to be secondary to femoral osteosarcoma. Conclusion In this case, our aim is to highlight the unusual clinical manifestations observed in a child with osteosarcoma, which can lead to a diagnosis delay and the subsequent impact on prognosis.
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Affiliation(s)
- Amine El Khassoui
- Department of Pediatric Orthopedic, Mother and Child Unit, University Hospital Mohamed VI of Marrakech, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
| | - Maha Attibbi
- Department of Pediatric Orthopedic, Mother and Child Unit, University Hospital Mohamed VI of Marrakech, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
| | - Mariem Touraif
- Department of Pediatric Orthopedic, Mother and Child Unit, University Hospital Mohamed VI of Marrakech, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
| | - El Mouhtadi Aghoutane
- Department of Pediatric Orthopedic, Mother and Child Unit, University Hospital Mohamed VI of Marrakech, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
| | - Tarik Salama
- Department of Pediatric Orthopedic, Mother and Child Unit, University Hospital Mohamed VI of Marrakech, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
| | - Redouane El Fezzazi
- Department of Pediatric Orthopedic, Mother and Child Unit, University Hospital Mohamed VI of Marrakech, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
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Kalfon E, Ayala-Paredes F. To Stop or Not to Stop DOACs During CIED Surgery, Is That the Question? JACC Clin Electrophysiol 2024; 10:133-134. [PMID: 38069970 DOI: 10.1016/j.jacep.2023.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/25/2023] [Indexed: 01/26/2024]
Affiliation(s)
- Eli Kalfon
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel; Cardiology Department, University Hospital of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Felix Ayala-Paredes
- Cardiology Department, University Hospital of Sherbrooke, Sherbrooke, Quebec, Canada.
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21
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Papudesi BN, Alvarado IM, Kaur P, Malayala SV, Guda SN, Mathew M, Potluri SD. A Case of Life-Threatening Abdominal Wall Hematoma Formation in a Patient on Warfarin Therapy with Concurrent Influenza Infection. Cureus 2024; 16:e52262. [PMID: 38352094 PMCID: PMC10863746 DOI: 10.7759/cureus.52262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 02/16/2024] Open
Abstract
Warfarin therapy provides extensive antithrombotic benefits and, thus, is widely used in the general population. However, as with most medications, there are also risks associated with warfarin use. Specifically, because of the narrow therapeutic window of this drug, patients taking it are at a much higher risk of accidental bleeding. Additionally, patients may also present with bleeding complications when infected with illnesses with coughing as a symptom, such as influenza or COVID-19. These patients have the potential to suffer hemorrhagic morbidities related to the increased intra-abdominal and intra-thoracic pressures that are generated from coughing. Moreover, a synergistic effect is seen when patients find themselves in a situation where they are taking anticoagulation therapy and become infected with illnesses such as influenza or COVID-19. We present a case in which an individual on warfarin therapy was infected with Influenza A. This combination of factors eventually led to massive hemorrhage and large abdominal wall hematoma formation. This case brings to light the importance of having a low threshold for considering the prospect of massive hemorrhage in any patient who is anticoagulated and develops a condition that is associated with increased abdominal pressure. Because these bleeding events can have devastating effects, raising awareness of this risk is increasingly important. Early detection of massive hemorrhage will lead to better outcomes and can ultimately be life-saving for these patients.
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Affiliation(s)
| | | | - Parneet Kaur
- Emergency, Civil Hospital, Mukerian, IND
- Internal Medicine, Suburban Community Hospital, Philadelphia, USA
| | | | - Sivakoti N Guda
- Internal Medicine, Suburban Community Hospital, Philadelphia, USA
| | - Mathew Mathew
- Internal Medicine, Suburban Community Hospital, Philadelphia, USA
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22
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Khayrullin AT, Kutlubaev MA, Rakhmatullin AR. [CT-predictors of unfavorable outcome in hemorrhagic stroke]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:37-41. [PMID: 38512093 DOI: 10.17116/jnevro202412403237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To analyze the relationship between the changes on non-contrast CT of the head in patients with acute hemorrhagic stroke and its unfavorable outcome within 90 days. MATERIAL AND METHODS The retrospective analysis of the clinical, demographic parameters and results of CT of the head of all patients admitted to the stroke unit of the district hospital between January 2015 and December 2021 was performed. The data of 131 patients were included in the work (52% males), average age was 65.75±14.1. RESULTS Fatal outcomes were recorded in 13.7% of cases. The age of the patient, severity of neurological deficit and CT-signs predicting hematoma expansion were independent predictors of unfavorable outcomes of hemorrhagic stroke within 90 days. CONCLUSION Detection of the sings predicting hematoma enlargement on CT scans improves prognostication of the outcomes of hemorrhagic stroke.
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23
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Zhao X, Ting SM, Sun G, Bautista Garrido J, Obertas L, Aronowski J. Clearance of Neutrophils From ICH-Affected Brain by Macrophages Is Beneficial and Is Assisted by Lactoferrin and CD91. Stroke 2024; 55:166-176. [PMID: 38063014 PMCID: PMC10842928 DOI: 10.1161/strokeaha.123.045194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/14/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Within hours after intracerebral hemorrhage (ICH) onset, masses of polymorphonuclear neutrophils (PMNs) infiltrate the ICH-affected brain. After degranulation involving controlled release of many toxic antimicrobial molecules, the PMNs undergo rapid apoptosis and then are removed by phagocytic microglia/macrophages (MΦ) through a process called efferocytosis. Effective removal of PMNs may limit secondary brain damage and inflammation; however, the molecular mechanisms governing these cleanup activities are not well understood. We propose that scavenger receptor CD91 on myeloid phagocytes especially in presence of CD91 ligand, LTF (lactoferrin, protein abundant in PMNs), plays an important role in clearance of dead apoptotic PMNs (ANs). METHODS Mice/rats were subjected to an autologous blood injection model of ICH. Primary cultured microglia were used to assess phagocytosis of ANs. Immunohistochemistry was employed to assess CD91 expression and PMN infiltration. CD91 knockout mice selectively in myeloid phagocytes (Mac-CD91-KO) were used to establish the CD91/LTF function in phagocytosis and in reducing ICH-induced injury, as assessed using behavioral tests, hematoma resolution, and oxidative stress. RESULTS Masses of PMNs are found in ICH-affected brain, and they contain LTF. MΦ at the outer border of hematoma are densely packed, expressing CD91 and phagocytosing ANs. Microglia deficient in CD91 demonstrate defective phagocytosis of ANs, and mice deficient in CD91 (Mac-CD91-KO) subjected to ICH injury have increased neurological dysfunction that is associated with impaired hematoma resolution (hemoglobin and iron clearance) and elevated oxidative stress. LTF that normally ameliorates ICH injury in CD91-proficient control mice shows reduced therapeutic effects in Mac-CD91-KO mice. CONCLUSIONS Our study suggests that CD91 plays a beneficial role in improving ANs phagocytosis and ultimately post-ICH outcome and that the beneficial effect of LTF in ICH is in part dependent on presence of CD91 on MΦ.
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Affiliation(s)
- Xiurong Zhao
- Department of Neurology, University of Texas HSC, McGovern Medical School, Houston
| | - Shun-Ming Ting
- Department of Neurology, University of Texas HSC, McGovern Medical School, Houston
| | - Guanghua Sun
- Department of Neurology, University of Texas HSC, McGovern Medical School, Houston
| | | | - Lidiya Obertas
- Department of Neurology, University of Texas HSC, McGovern Medical School, Houston
| | - Jaroslaw Aronowski
- Department of Neurology, University of Texas HSC, McGovern Medical School, Houston
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Creta A, Ventrella N, Earley MJ, Finlay M, Sporton S, Maclean E, Kanthasamy V, Lemos Silva Di Nubila BC, Ricciardi D, Calabrese V, Picarelli F, Hunter RJ, Lambiase PD, Schilling RJ, Grigioni F, Monkhouse C, Muthumala A, Moore P, Providencia R, Chow A. DOACs vs Vitamin K Antagonists During Cardiac Rhythm Device Surgery: A Multicenter Propensity-Matched Study. JACC Clin Electrophysiol 2024; 10:121-132. [PMID: 37897463 DOI: 10.1016/j.jacep.2023.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND There is a paucity of data comparing vitamin K antagonists (VKAs) to direct oral anticoagulants (DOACs) at the time of cardiac implantable electronic device (CIED) surgery. Furthermore, the best management of DOACs (interruption vs continuation) is yet to be determined. OBJECTIVES This study aimed to compare the incidence of device-related bleeds and thrombotic events based on anticoagulant type (DOAC vs VKA) and regimen (interrupted vs uninterrupted). METHODS This was an observational multicenter study. We included patients on chronic oral anticoagulation undergoing CIED surgery. Patients were matched using propensity scoring. RESULTS We included 1,975 patients (age 73.8 ± 12.4 years). Among 1,326 patients on DOAC, this was interrupted presurgery in 78.2% (n = 1,039) and continued in 21.8% (n = 287). There were 649 patients on continued VKA. The matched population included 861 patients. The rate of any major bleeding was higher with continued DOAC (5.2%) compared to interrupted DOAC (1.7%) and continued VKA (2.1%) (P = 0.03). The rate of perioperative thromboembolism was 1.4% with interrupted DOAC, whereas no thromboembolic events occurred with DOAC or VKA continuation (P = 0.04). The use of dual antiplatelet therapy, DOAC continuation, and male sex were independent predictors of major bleeding on a multivariable analysis. CONCLUSIONS In this large real-world cohort, a continued DOAC strategy was associated with a higher bleeding risk compared to DOAC interruption or VKA continuation in patients undergoing CIED surgery. However, DOAC interruption was associated with increased thromboembolic risk. Concomitant dual antiplatelet therapy should be avoided whenever clinically possible. A bespoke approach is necessary, with a strategy of minimal DOAC interruption likely to represent the best compromise.
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Affiliation(s)
- Antonio Creta
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Institute of Health Informatics, University College London, London, United Kingdom.
| | | | - Mark J Earley
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Malcolm Finlay
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Simon Sporton
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Edward Maclean
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | | | | | - Danilo Ricciardi
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Vito Calabrese
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | | | - Ross J Hunter
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Pier D Lambiase
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | | | | | | | - Amal Muthumala
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Philip Moore
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Rui Providencia
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Institute of Health Informatics, University College London, London, United Kingdom
| | - Anthony Chow
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
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You S, Zheng D, Yoshimura S, Ouyang M, Han Q, Wang X, Cao Y, Delcourt C, Song L, Arima H, Chen X, Liu CF, Lindley RI, Robinson T, Anderson CS, Chalmers J. Optimum Baseline Clinical Severity Scale Cut Points for Prognosticating Intracerebral Hemorrhage: INTERACT Studies. Stroke 2024; 55:139-145. [PMID: 38018833 DOI: 10.1161/strokeaha.123.044538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/27/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND The optimal cut point of baseline National Institutes of Health Stroke Scale (NIHSS) and Glasgow Coma Scale scores for prognosticating acute intracerebral hemorrhage (ICH) is unknown. METHODS Secondary analyses of participant data are from the INTERACT (Intensive Blood Pressure Reduction in Acute Intracerebral Hemorrhage Trials) 1 and 2 studies. Receiver operating characteristic analyses were used to compare the predictive performance of baseline NIHSS and Glasgow Coma Scale scores, ICH score, and max-ICH score. Optimal cut points for predicting 90-day clinical outcomes (death or major disability [defined as modified Rankin Scale scores 3-6], major disability [defined as modified Rankin Scale scores 3-5], and death alone) were determined using the Youden index. Logistic regression models were adjusted for age, sex, hematoma volume, and other known risk factors for poor prognosis. We validated our findings in the INTERACT1 database. RESULTS There were 2829 INTERACT2 patients (age, 63.5±12.9 years; male, 62.9%; ICH volume, 10.96 [5.77-19.49] mL) included in the main analyses. The baseline NIHSS score (area under the curve, 0.796) had better prognostic utility for predicting death or major disability than the Glasgow Coma Scale score (area under the curve, 0.650) and ICH score (area under the curve, 0.674) and was comparable to max-ICH score (area under the curve, 0.789). Similar findings were observed when assessing the outcome of major disability. A cut point of 10 on baseline NIHSS optimally (sensitivity, 77.5%; specificity, 69.2%) predicted death or major disability (adjusted odds ratio, 4.50 [95% CI, 3.60-5.63]). The baseline NIHSS cut points that optimally predicted major disability and death alone were 10 and 12, respectively. The predictive effect of NIHSS≥10 for poor functional outcomes was consistent in all subgroups including age and baseline hematoma volume. Results were consistent when analyzed in the independent INTERACT1 validation database. CONCLUSIONS In patients with mild-to-moderate ICH, a baseline NIHSS score of ≥10 was optimal for predicting poor outcomes at 90 days. Prediction based on baseline NIHSS is better than baseline Glasgow Coma Scale score. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifiers: NCT00226096 and NCT00716079.
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Affiliation(s)
- Shoujiang You
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China (S. You, Y.C., C.-F.L.)
| | - Danni Zheng
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Kensington, Australia (D.Z., M.O., X.W., C.D., L.S., X.C., R.I.L., C.S.A., J.C.)
| | - Sohei Yoshimura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S. Yoshimura)
| | - Menglu Ouyang
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Kensington, Australia (D.Z., M.O., X.W., C.D., L.S., X.C., R.I.L., C.S.A., J.C.)
- The George Institute for Global Health China, Beijing, China (M.O., L.S., C.S.A.)
| | - Qiao Han
- Department of Neurology, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, China (Q.H.)
| | - Xia Wang
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Kensington, Australia (D.Z., M.O., X.W., C.D., L.S., X.C., R.I.L., C.S.A., J.C.)
| | - Yongjun Cao
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China (S. You, Y.C., C.-F.L.)
| | - Candice Delcourt
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Kensington, Australia (D.Z., M.O., X.W., C.D., L.S., X.C., R.I.L., C.S.A., J.C.)
- Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia (C.D.)
| | - Lili Song
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Kensington, Australia (D.Z., M.O., X.W., C.D., L.S., X.C., R.I.L., C.S.A., J.C.)
- The George Institute for Global Health China, Beijing, China (M.O., L.S., C.S.A.)
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Fukuoka University, Japan (H.A.)
| | - Xiaoying Chen
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Kensington, Australia (D.Z., M.O., X.W., C.D., L.S., X.C., R.I.L., C.S.A., J.C.)
| | - Chun-Feng Liu
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China (S. You, Y.C., C.-F.L.)
| | - Richard I Lindley
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Kensington, Australia (D.Z., M.O., X.W., C.D., L.S., X.C., R.I.L., C.S.A., J.C.)
- Westmead Clinical School, University of Sydney, NSW, Australia (R.I.L.)
| | - Thompson Robinson
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, United Kingdom (T.R.)
| | - Craig S Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Kensington, Australia (D.Z., M.O., X.W., C.D., L.S., X.C., R.I.L., C.S.A., J.C.)
- The George Institute for Global Health China, Beijing, China (M.O., L.S., C.S.A.)
- Neurology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.S.A.)
| | - John Chalmers
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Kensington, Australia (D.Z., M.O., X.W., C.D., L.S., X.C., R.I.L., C.S.A., J.C.)
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Raab S, Huber L, Fortelny R, Shamiyeh A. Laparoscopic transabdominal preperitoneal (TAPP) groin hernia repair using n-butyl-2-cyanoacrylate (LiquiBandFIX8) for mesh fixation and peritoneal closure: case report about extraperitoneal hematoma. Ann Med Surg (Lond) 2024; 86:481-484. [PMID: 38222725 PMCID: PMC10783228 DOI: 10.1097/ms9.0000000000001439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/17/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction A symptomatic inguinal hernia is a prevalent condition that typically requires surgical intervention. Various surgical approaches have been established for hernia repair, including several techniques for peritoneal closure and mesh fixation in laparoscopic surgery. N-butyl-2-cyanoacrylate, such as LiquiBandFIX8, offers a time-saving alternative to invasive methods for both mesh fixation and peritoneal closure. While n-butyl-2-cyanoacrylate is employed in various closure procedures, LiquiBandFIX8 is specifically designed for mesh fixation in inguinal hernia repair. Case presentation We present a case of a 68-year old man undergoing transabdominal preperitoneal inguinal hernia repair under full heparinization. LiquiBandFIX8 was employed for mesh fixation and peritoneal closure. Upon conducting a revision laparoscopy due to a significant postoperative hematoma, we found that the mesh and peritoneum remained undamaged and fully sealed, indicating an effective fixing technique. Both the initial repair and the subsequent revision surgery were documented and the videos were subsequently analyzed. Conclusion LiquiBandFIX8 provides a reliable adhesive strength and appropriate application for peritoneal closure and mesh fixation. When encountering extraperitoneal fluid collection, there is no anticipation of intraabdominal complications.
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Affiliation(s)
- Sandra Raab
- Department of General and Visceral Surgery, Kepler University Hospital
- Johannes Kepler University, Linz
| | - Livia Huber
- Department for Urology, Hospital Baden-Mödling, Baden, Austria
| | - René Fortelny
- Private Clinic Confraternity, General, and Visceral Surgery, Vienna, Austria
| | - Andreas Shamiyeh
- Department of General and Visceral Surgery, Kepler University Hospital
- Johannes Kepler University, Linz
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De Jonge B, Pardon B, Dewulf J, Goossens E, het Lam J, van Garderen E, Roels S, Callens J, Petitjean T, Chiers K. Epidemiology of Bovine Hemorrhagic Bowel Syndrome in Belgium and The Netherlands. Animals (Basel) 2023; 14:107. [PMID: 38200838 PMCID: PMC10778070 DOI: 10.3390/ani14010107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/24/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
Hemorrhagic bowel syndrome (HBS) is a poorly understood, sporadic and often fatal disease in cattle. Although, HBS is considered an important disease in dairy cattle, epidemiological data is largely lacking. This study describes the epidemiology of HBS in Belgium and the Netherlands, based on necropsy records from 2009 to 2022, and reports characteristics from 27 cows and 35 dairy operations with HBS, gathered through a survey. The annual incidence of HBS has a significantly increasing trend both at cow and herd level, with incidence above 3.2% in necropsied mature dairy cattle in the most recent years. Estimated herd-level incidence in the Netherlands was double the estimated incidence in Belgium, which might be explained by higher herd size in the Netherlands. Occurrence of HBS was most prevalent in fall, being 40.1% higher than the average of the other seasons. In 35 Flemish (Belgian) surveyed dairy herds with HBS, manifestation of HBS was mostly as solitary cases, and if multiple cases occurred, the time interval was highly variable. In addition, the majority of cows with HBS (61.1%; 16/26) were in more than 100 days lactation. In conclusion, HBS is an important and possibly emerging disease in dairy cattle in Belgium and the Netherlands.
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Affiliation(s)
- Bert De Jonge
- Department of Pathobiology, Pharmacology and Zoological Medicine, Ghent University, 9820 Merelbeke, Belgium (K.C.)
| | - Bart Pardon
- Department of Internal Medicine, Reproduction and Population Medicine, Ghent University, 9820 Merelbeke, Belgium (J.D.)
| | - Jeroen Dewulf
- Department of Internal Medicine, Reproduction and Population Medicine, Ghent University, 9820 Merelbeke, Belgium (J.D.)
| | - Evy Goossens
- Department of Pathobiology, Pharmacology and Zoological Medicine, Ghent University, 9820 Merelbeke, Belgium (K.C.)
| | - Jasper het Lam
- Royal GD (Animal Health Service), 7418 EZ Deventer, The Netherlands
| | | | - Stefan Roels
- Animal Health Service-Flanders (DGZ), 8820 Torhout, Belgium; (S.R.)
| | - Jozefien Callens
- Animal Health Service-Flanders (DGZ), 8820 Torhout, Belgium; (S.R.)
| | | | - Koen Chiers
- Department of Pathobiology, Pharmacology and Zoological Medicine, Ghent University, 9820 Merelbeke, Belgium (K.C.)
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Rajmohan S, Gao C, Chacon Garcia M, Miglior I, Pitkin L. Lemierre's Syndrome Secondary to Shoulder Hematoma Complicated by COVID-19: A Case Report. Ear Nose Throat J 2023:1455613231215166. [PMID: 38078435 DOI: 10.1177/01455613231215166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
This case report illustrates a unique presentation of Lemierre's syndrome precipitated by Fusobacterium necrophorum. This case report describes a 20-year-old patient who developed Lemierre's syndrome secondary to a shoulder hematoma and neck abscess with multiple systemic complications in the absence of tonsillitis or oropharyngeal infection. Two weeks prior to presentation, the patient sustained a right shoulder injury and contracted COVID-19. Due to his Lemierre's syndrome, he developed right internal jugular vein and subclavian vein thrombosis, septic lung emboli, right sided Horner's syndrome, disseminated intravascular coagulation, pelvic collection, septic arthritis of pubic symphysis and osteomyelitis of the right pubic bone, and proximal left femoral shaft. The patient received non-operative and operative management to manage his Lemierre's syndrome including surgical drainage, antibiotics, and anticoagulation; he was discharged following an extended hospital stay. This case report highlights a rare presentation of Lemierre's syndrome secondary to a shoulder hematoma in a COVID-19 positive patient, and its potential systemic and life-threatening complications. Its importance is highly relevant in the context of the COVID-19 pandemic. Further studies are warranted to explore the effect of preceding COVID-19 infections on the microbiological profile in Lemierre's syndrome.
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Affiliation(s)
| | - Chuanyu Gao
- ENT Department, Royal Surrey County Hospital, Guildford, UK
| | | | - Isabel Miglior
- ENT Department, Royal Surrey County Hospital, Guildford, UK
| | - Lisa Pitkin
- ENT Department, Royal Surrey County Hospital, Guildford, UK
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29
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Parry-Jones AR. Hematoma Expansion Shift Analysis: A Novel Approach to Understanding Recombinant Factor VIIa in Intracerebral Hemorrhage. Stroke 2023; 54:2999-3001. [PMID: 38011239 DOI: 10.1161/strokeaha.123.045226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Affiliation(s)
- Adrian R Parry-Jones
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance and University of Manchester, United Kingdom
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30
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Ratano S, Jovanovic B, Ouabo EC. Effects of the Percutaneous Carbon Dioxide Therapy on Post-surgical and Post-traumatic Hematoma, Edema and Pain. J Orthop Case Rep 2023; 13:11-17. [PMID: 38162355 PMCID: PMC10753674 DOI: 10.13107/jocr.2023.v13.i12.4058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/08/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Carbon dioxide therapy (CDT) has been used since the Roman Empire to improve the microcirculation and oxygenation of tissues altered. The classical indications are vasculopathies and ischemic diseases. Hypothesis The CDT could be effective in favoring joint mobility recovery and pain reduction in patients with post-surgical or post-traumatic hematoma, edema, and pain. Study Design Case report. Material and Methods Eight patients were treated once a day for 5-10 days; a single session lasted 50 min. For post-surgical cases, the treatment began the day or the day after they were discharged from the hospital. Result For all patients in this series, the CDT has brought clinical benefits in terms of decreasing pain and improving of joint mobility. Conclusion The CDT is a safe and effective treatment to provide a greater amount of oxygen to the injured tissues. It favors the healing of post-surgical and post-traumatic hematoma and edema, promoting the mobility recovery of patients.
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Affiliation(s)
- Salvatore Ratano
- Department of Orthopaedic Surgery, University of Palermo, Palermo, Italy
| | - Biljana Jovanovic
- Private Practice, Center of Orthopedic Surgery, Clinique Bois-Cerf, 1006 Lausanne, Switzerland
| | - Eric Choudja Ouabo
- Private Practice, Center of Orthopedic Surgery, Clinique Bois-Cerf, 1006 Lausanne, Switzerland
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Palenske R, Steele B, Davis R. 65-year-old female presenting with left thigh pain and episode of syncope. J Am Coll Emerg Physicians Open 2023; 4:e13069. [PMID: 38029022 PMCID: PMC10663647 DOI: 10.1002/emp2.13069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Ryan Palenske
- Geisinger Medical CenterEmergency MedicineDanvillePennsylvaniaUSA
| | - Brendan Steele
- Geisinger Medical CenterEmergency MedicineDanvillePennsylvaniaUSA
| | - Richard Davis
- Geisinger Medical CenterEmergency MedicineDanvillePennsylvaniaUSA
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Nakajima T, Nakanishi K, Harada K, Narimatsu E, Kawaharada N. A Case of Massive Retroperitoneal Hematoma After High-Energy Trauma. Cureus 2023; 15:e51080. [PMID: 38269227 PMCID: PMC10807929 DOI: 10.7759/cureus.51080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2023] [Indexed: 01/26/2024] Open
Abstract
A 66-year-old female suffered from high-energy trauma due to a traffic accident, resulting in injuries to the iliac artery and the superior mesenteric artery. She underwent endovascular embolization for vascular occlusion and an open surgical procedure to control bleeding from the superior mesenteric artery. A substantial retroperitoneal hematoma was observed on the right side, making primary closure challenging. A hematoma evacuation procedure was performed using a right retroperitoneal approach, successfully relieving the compression from the posterior aspect.
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Affiliation(s)
- Tomohiro Nakajima
- Cardiovascular Surgery Department, Sapporo Medical University, Sapporo, JPN
| | - Keitaro Nakanishi
- Cardiovascular Surgery Department, Sapporo Medical University, Sapporo, JPN
| | - Keisuke Harada
- Emergency Department, Sapporo Medical University, Sapporo, JPN
| | - Eichi Narimatsu
- Emergency Department, Sapporo Medical University, Sapporo, JPN
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Yogendrakumar V, Mayer SA, Steiner T, Broderick JP, Dowlatshahi D. Exploring Hematoma Expansion Shift With Recombinant Factor VIIa: A Pooled Analysis of 4 Randomized Controlled Trials. Stroke 2023; 54:2990-2998. [PMID: 37805927 DOI: 10.1161/strokeaha.123.043209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/08/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Hematoma expansion shift (HES) analysis can be used to assess the biological effect of a hemostatic therapy for intracerebral hemorrhage. In this study, we applied HES analysis to individual patient data from 4 randomized controlled trials evaluating rFVIIa (recombinant factor VIIa) 80 μg/kg to placebo. METHODS We generated polychotomous strata of HES using absolute growth thresholds (≤0/<6/≥6 mL) and quintiles of percent volume change. The relationship between treatment and HES was assessed using proportional odds models. Differences in subgroups based on baseline volume (≥ or <20 mL), and time from symptom onset to treatment (≤ or >2 hours) were explored with testing for interactions. RESULTS The primary analysis included 721 patients. At 24 hours, 36% (134/369) of rFVIIa-treated patients exhibited no hematoma expansion as compared with 25% of placebo (88/352)-treated patients. Significant expansion (≥6 mL) was reduced by 10% in those treated with rFVIIa-(adjusted common odds ratio [acOR], 0.57 [95% CI, 0.43-0.75]). An examination of percent change similarly showed a shift across the spectrum of expansion (acOR, 0.61 [95% CI, 0.47-0.80]). In both groups, mild-to-moderate expansion was observed in 38% to 47% of patients, depending on the threshold used. Differences in absolute HES between the rFVIIa and placebo groups were more pronounced in patients with baseline hemorrhage volumes ≥20 mL (acOR, 0.48 [95% CI, 0.30-0.76] versus <20 mL: acOR, 0.67 [95% CI, 0.47-0.95]; Pinteraction=0.02). No treatment interaction in patients treated within 2 or after 2 hours from onset was observed (acOR, 0.42 [95% CI, 0.19-0.91 versus >2 hours: acOR, 0.59 [95% CI, 0.44-0.79]; Pinteraction=0.30). CONCLUSIONS The association between rFVIIa and hematoma growth arrest is most pronounced in patients with larger baseline volumes but is evident across the full spectrum of treated patients.
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Affiliation(s)
- Vignan Yogendrakumar
- Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia (V.Y.)
| | - Stephan A Mayer
- Departments of Neurology and Neurosurgery, New York Medical College, Valhalla, NY (S.A.M.)
| | - Thorsten Steiner
- Department of Neurology, Klinikum Frankfurt Höchst, Germany (T.H.)
- Department of Neurology, Heidelberg University Hospital, Germany (T.H.)
| | | | - Dar Dowlatshahi
- Department of Medicine (Neurology), University of Ottawa and Ottawa Hospital Research Institute, Ontario, Canada (D.D.)
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Thanasa A, Thanasa E, Grapsidi V, Xydias EM, Gerokostas EE, Antoniou IR, Kamaretsos E, Ziogas AC, Paraoulakis I, Thanasas I. Surgical Treatment of a Large Post-cesarean Hematoma in the Retzius Space Accompanied by a Blood Coagulation Disorder: A Rare Case Report. Cureus 2023; 15:e51417. [PMID: 38299139 PMCID: PMC10828530 DOI: 10.7759/cureus.51417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 02/02/2024] Open
Abstract
Hematoma in the Retzius space after a cesarean section is a rare complication. The Retzius space, also referred to as the prevesical or retropubic space, represents an extraperitoneal artificial cavity situated between the pubic symphysis and the bladder. In instances where conservative treatment involving vigilant monitoring along with analgesics and antibiotics or ultrasound-guided percutaneous puncture proves unsuccessful, re-operation becomes imperative. Our case report concerns a second-parity pregnant patient who underwent a cesarean section in the 39th gestational week. A decrease in hemoglobin level on the third postoperative day, combined with the onset of febrile infection, an increase in inflammatory markers, and the manifestation of lower abdominal pain, prompted a thorough investigation of the puerperant. Imaging revealed the existence of a hematoma in the Retzius space associated with a mild blood coagulation disorder. Subsequently, the unsuccessful outcome of the ultrasound-guided percutaneous puncture of the hematoma, combined with the persistence of clinico-laboratory findings, led to the decision to perform a re-laparotomy on the 10th postoperative day after the cesarean section. During the surgery, a large hematoma was identified in the Retzius space, extending below the rectus abdominis muscles. The procedure involved surgical drainage of the hematoma, meticulous hemostasis, and the placement of negative pressure drainage in the Retzius space. The patient was discharged from the clinic on the fifth postoperative day after re-operation. Ten days later, both blood tests and ultrasounds were without abnormal findings. In this paper, following the case presentation, a brief review is provided regarding the diagnostic and therapeutic approach of patients with hematoma in the Retzius space after cesarean section.
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Affiliation(s)
- Anna Thanasa
- Department of Health Sciences, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, GRC
| | - Efthymia Thanasa
- Department of Health Sciences, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, GRC
| | - Vasiliki Grapsidi
- Department of Obstetrics and Gynecology, General Hospital of Trikala, Trikala, GRC
| | - Emmanouil M Xydias
- Department of Obstetrics and Gynecology, EmbryoClinic IVF, Thessaloniki, GRC
| | | | | | - Evangelos Kamaretsos
- Department of Obstetrics and Gynecology, General Hospital of Trikala, Trikala, GRC
| | - Apostolos C Ziogas
- Department of Obstetrics and Gynecology, University of Thessaly, Larissa, GRC
| | - Ioannis Paraoulakis
- Department of Obstetrics and Gynecology, General Hospital of Trikala, Trikala, GRC
| | - Ioannis Thanasas
- Department of Obstetrics and Gynecology, General Hospital of Trikala, Trikala, GRC
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Shumaker L, Zulia N, Kennedy E, Beilan J, Ortiz N, Baumgarten A. Delayed closed-suction drain removal following inflatable penile prosthesis placement: a multi-institutional experience. J Sex Med 2023; 20:1440-1445. [PMID: 37872726 DOI: 10.1093/jsxmed/qdad132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/11/2023] [Accepted: 09/11/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND There are little published data regarding longer percutaneous drain durations following inflatable penile prosthesis placement; despite this, drain proponents suggest reduced scrotal hematoma formation, while detractors cite the risk of retrograde device seeding. AIM Here, we quantify the outcomes of a multi-institutional cohort with drain durations of 48 hours or greater. METHODS Data were collected retrospectively for patients undergoing primary 3-piece inflatable penile prosthesis (IPP) placement who had a postoperative drain placed. Cases were performed by 3 surgeons at 3 high-volume centers between January 1, 2020, and March 31, 2022. It was the routine practice of these surgeons to leave percutaneous drains for an interval of 48 hours or greater. R software was used to perform statistical analysis and data visualization. OUTCOMES Primary outcomes included rates of infection and hematoma formation. Secondary outcomes included device explantation. RESULTS During the study period, there were 224 patients meeting initial inclusion criteria. Of these, 15 patients had their drains removed before 48 hours, leaving 209 patients for the analysis. Mean drain duration was 67 ± 24.7 hours. The mean follow-up interval was 170 days. Diabetes mellitus was present in 84 (40%) patients with a mean hemoglobin A1c of 7.2%. Penoscrotal and infrapubic approaches were employed (n = 114 [54.5%] vs n = 95 [45.5%]). Reservoir location was split between space of Retzius and high submuscular, with space of Retzius being more common (n = 164 [78.5%] vs n = 45 [21.5%]). Discrete hematomas were observed in 7 patients, with subsequent operative intervention on 2. Notably, both of these were infection cases. There were 3 (1.4%) total device infections. Revision for noninfection causes was required in 9 (4.3%) patients. Fisher's exact testing demonstrated significant association between hematoma formation and anticoagulation and/or antiplatelet therapy (P = .017). On multivariable logistic regression, only anticoagulation and/or antiplatelet therapy remained significant (P = .035). CLINICAL IMPLICATIONS Maintaining percutaneous closed-suction bulb drains for >48 hours following IPP placement is safe. STRENGTHS AND LIMITATIONS This multi-institutional study fills a hole in IPP perioperative literature, as there have been no previously published data regarding drain durations >48 hours. The primary limitations are the retrospective nature and lack of a control population. CONCLUSION Maintaining closed-suction bulb drains for >48 hours following IPP implantation is safe and associated with infection rates comparable to other modern cohorts and a very low rate of hematoma formation.
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Affiliation(s)
- Luke Shumaker
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35294, United States
| | - Nicholas Zulia
- Advanced Urology Institute, Largo, FL 33771, United States
| | - Emmett Kennedy
- Department of Urology, University of Virginia, Charlottesville, VA 22903, United States
| | | | - Nicolas Ortiz
- Department of Urology, University of Virginia Health System, Charlottesville, Virginia 22903, United States
| | - Adam Baumgarten
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35294, United States
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Perkov S, Makhortov M, Grishin O, Perevoschikov S, Prikhozhdenko ES, Bratashov D, Gorin D. Optoacoustic monitoring of bilirubin photodegradation. J Biophotonics 2023; 16:e202200339. [PMID: 37345342 DOI: 10.1002/jbio.202200339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 05/14/2023] [Accepted: 06/02/2023] [Indexed: 06/23/2023]
Abstract
Hematomas resulted from trauma are very common, and the efficacy of existing treatment techniques is limited. Phototherapy can be used to expedite healing and improve the appearance of the damaged tissue. Efficient phototherapy requires determination of chromophore composition in hematoma, which can be provided by the optoacoustic (OA) technique, as it combines high spatial resolution and optical contrast. Here, we conducted experiments on photodegradation of bilirubin in gelatin slin phantoms. We have demonstrated that the OA technique allows monitoring of bilirubin concentration during photodegradation, and also distinguishing bilirubin concentration in depth. The obtained results suggest that OA monitoring may be used for efficient hematoma phototherapy.
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Affiliation(s)
- Sergei Perkov
- Photonics Center, Skolkovo Institute of Science and Technology, Moscow, Russia
| | | | - Oleg Grishin
- Science Medical Center, Saratov State University, Saratov, Russia
| | | | | | - Daniil Bratashov
- Science Medical Center, Saratov State University, Saratov, Russia
| | - Dmitry Gorin
- Photonics Center, Skolkovo Institute of Science and Technology, Moscow, Russia
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Gartly R, Quinn TJ. Stroke Literature Synopses (Clinical). Stroke 2023; 54:e483-e484. [PMID: 37871242 DOI: 10.1161/strokeaha.123.044632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Affiliation(s)
- Rachael Gartly
- School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom
| | - Terence J Quinn
- School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom
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Cabrera JP, Gary MF, Muthu S, Yoon ST, Kim HJ, Cho SK, Ćorluka S, Lewis SJ, Kato S, Buser Z, Wang JC, Hsieh PC. Surgeon Preferences Worldwide in Wound Drain Utilization in Open Lumbar Fusion Surgery for Degenerative Pathologies. Global Spine J 2023:21925682231210184. [PMID: 37897691 DOI: 10.1177/21925682231210184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/30/2023] Open
Abstract
STUDY DESIGN Cross-sectional survey. OBJECTIVE Although literature does not recommend routine wound drain utilization, there is a disconnect between the evidence and clinical practice. This study aims to explore into this controversy and analyze the surgeon preferences related to drain utilization, and the factors influencing drain use and criterion for removal. METHODS A survey was distributed to AO Spine members worldwide. Surgeon demographics and factors related to peri-operative drain use in 1 or 2-level open fusion surgery for lumbar degenerative pathologies were collected. Multivariate analyses by drain utilization, and criterion of removal were conducted. RESULTS 231 surgeons participated, including 220 males (95.2%), orthopedics (178, 77.1%), and academic/university-affiliated (114, 49.4%). Most surgeons preferred drain use (186, 80.5%) and subfascial drains (169, 73.2%). Drains were removed based on duration by 52.87% of the surgeons, but 27.7% removed drains based on outputs. On multivariable analysis, significant predictors of drain use were surgeon's aged 35-44 (OR = 11.9, 95% CI = 1.2-117.2, P = .034), 45-54 (29.1, 3.1-269.6, P = .003), 55-64 (8.9, 1.4-56.5, .019), and wound closure using coaptive films (6.0, 1.2-29.0, P = .025). Additionally, surgeons from Asia Pacific (OR = 5.19, 95% CI = 1.65-16.38, P = .005), Europe (3.55, 1.22-10.31, P = .020), and Latin America (4.40, 1.09-17.83, .038) were more likely to remove drain based on time duration, but surgeons <5 years of experience (10.23, 1.75-59.71, P = .010) were more likely to remove drains based on outputs. CONCLUSIONS Most spine surgeons worldwide prefer to place a subfascial wound drain for degenerative open lumbar surgery. The choice for drain placement is associated with the surgeon's age and use of coaptive films for wound closure, while the criterion for drain removal is associated with the surgeons' region of practice and experience.
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Affiliation(s)
- Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile
- Faculty of Medicine, University of Concepción, Concepción, Chile
| | - Matthew F Gary
- Department of Neurosurgery, Emory University, Atlanta, GA, USA
| | - Sathish Muthu
- Orthopaedic Research Group, Coimbatore, India
- Department of Orthopaedics, Government Medical College, Karur, India
- Department of Biotechnology, Faculty of Engineering, Karpagam Academy of Higher Education, Coimbatore, India
| | - S Tim Yoon
- Department of Orthopedics, Emory University, Atlanta, GA, USA
| | - Ho-Joong Kim
- Spine Center and Department of Orthopedic Surgery, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seoul, Republic of South Korea
| | - Samuel K Cho
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stipe Ćorluka
- Spinal Surgery Division, Department of Traumatology, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia
- Department of Anatomy and Physiology, University of Applied Health Sciences, Zagreb, Croatia
| | - Stephen J Lewis
- Department of Orthopaedics, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, ON, Canada
| | - So Kato
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Zorica Buser
- Gerling Institute, Brooklyn, NY, USA
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, USA
| | - Jeffrey C Wang
- USC Spine Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Patrick C Hsieh
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Choi KY, Choi S, Jeong S, Won TB. Successful Endoscopic Transsphenoidal Approach Treatment of Sphenoid Sinus Organized Hematoma Causing Visual Deficit: A Case Report. Medicina (Kaunas) 2023; 59:1802. [PMID: 37893520 PMCID: PMC10608076 DOI: 10.3390/medicina59101802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/20/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023]
Abstract
Background: Organized hematoma in the sphenoid sinus is rare, but serious complications, such as visual deficits, can occur. Three such case reports have been published previously in the literature; however, none have achieved complete recovery of the vision. Case presentation: A 69-year-old male patient was referred to the ear, nose, and throat department with an expansile soft tissue mass filling the right sphenoid sinus and blurry vision in his right eye. Complete mass removal was achieved by a wide opening of the sphenoid sinus via an endoscopic transsphenoidal approach, followed by cauterization of the feeding artery and coverage by a nasoseptal flap. The patient's vision was restored after the operation, and he declared no visual symptoms until the latest follow-up (one year after the surgery). Conclusions: Complete excision with an endoscopic endonasal transsphenoidal approach can restore visual deterioration caused by a sphenoid sinus organized hematoma.
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Affiliation(s)
- Kyu Young Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea; (K.Y.C.); (S.C.)
| | - Sun Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea; (K.Y.C.); (S.C.)
| | - Suji Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Tae-Bin Won
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
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Lee JH, Yun J. Diffuse Large B-Cell lymphoma Misdiagnosed as a Hematoma: Case Report. Medicina (Kaunas) 2023; 59:1775. [PMID: 37893492 PMCID: PMC10608036 DOI: 10.3390/medicina59101775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 09/28/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
Background: Diffuse large B-cell lymphoma (DLBCL), the most common subtype of non-Hodgkin's lymphoma, often presents diagnostic challenges due to its diverse clinical presentation. We present a case of DLBCL that was initially misdiagnosed as a hematoma, highlighting the importance of considering malignancy when faced with unresponsive soft tissue swelling. Methods: A 76-year-old man presented to the emergency department with right periorbital swelling and ecchymosis following a traumatic injury. Despite ongoing anticoagulant therapy (warfarin) for atrial fibrillation, the symptoms persisted. A CT scan of the facial bones revealed a large, irregular, homogeneous mass. Initially, the clinical history and radiologic findings suggested an extraconal hematoma. As a result, an incision and drainage procedure was performed, and the old blood was evacuated. However, the patient's symptoms continued to worsen. A follow-up CT scan showed enlargement of the lesion, prompting a surgical excisional biopsy. Results: Pathologic examination of the excised mass revealed a diffuse infiltrate of lymphocytes surrounding the tissue, confirming the diagnosis of diffuse large B-cell lymphoma (DLBCL). The patient was subsequently referred to hematology for further management. Conclusions: Although rare, DLBCL is associated with a challenging prognosis. This case highlights the diagnostic complexities that can arise, particularly when factors such as prior injury and anticoagulant therapy confound the clinical picture. The initial misclassification of the condition as a hematoma led to a delay in diagnosis and the subsequent initiation of treatment. Therefore, it is imperative to remain vigilant and consider malignancy as a potential underlying cause of unresponsive soft tissue swelling. Timely recognition and accurate diagnosis are paramount to improving patient outcomes in DLBCL, an aggressive lymphoma with a diverse clinical presentation.
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Affiliation(s)
| | - Jiyoung Yun
- Department of Plastic and Reconstructive Surgery, Busan Paik Hospital, School of Medicine, Inje University, Busan 47392, Republic of Korea;
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Mohamad T, Kumar S, Kaki A, Varrassi G, Markiewicz R. A Report of Cauda Equina Syndrome Caused by Spinal Epidural Hematoma, a Complication of Deep Vein Thrombosis (DVT) Management. Cureus 2023; 15:e47969. [PMID: 38034142 PMCID: PMC10685988 DOI: 10.7759/cureus.47969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
This case report delves into the infrequent yet substantial occurrence of cauda equina syndrome (CES) arising from a spinal epidural hematoma (SEH), a potential complication during deep vein thrombosis (DVT) treatment. An 83-year-old female patient previously diagnosed with various medical conditions, including moderate spinal stenosis, chronic kidney disease, and chronic lower extremity stasis, was detected with notable iliofemoral DVT during an office-based venous study. The patient was urgently referred to the Emergency Department. Following hospitalization, her cardiologist diagnosed DVT, prompted by the patient's report of significant swelling and pain in the left lower limb over the past week. A venous ultrasound unveiled occlusive DVT originating from the common femoral vein, extending down to the infrapopliteal vessels, with a complete absence of venous Doppler signal. Employing the ClotTriever device (Terumo Corporation, Shibuya City, Tokyo, Japan), a mechanical aspiration thrombectomy procedure, effectively resolved DVT. However, CES was diagnosed in the patient on a subsequent day due to the emergence of SEH. This case underscores the intricate balance required when managing DVT, involving anticoagulation or alternate therapies while acknowledging the potential risk of hemorrhagic complications leading to epidural hematoma and consequent CES. It is crucial for clinicians managing DVT and employing therapeutic strategies to be aware of this infrequent yet pivotal complication. This report highlights the significance of prompt identification and intervention in such cases, emphasizing the need for vigilance and understanding of potential complications during DVT treatment.
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Affiliation(s)
- Tamam Mohamad
- Cardiovascular Medicine, Wayne State University, Detroit, USA
| | - Satesh Kumar
- Medicine and Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | - Amir Kaki
- Cardiology, Heart & Vascular Institute, Dearborn, USA
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Fischer P, Tamim I, Sugimoto K, Morais A, Imai T, Takizawa T, Qin T, Schlunk F, Endres M, Yaseen MA, Chung DY, Sakadzic S, Ayata C. Spreading Depolarizations Suppress Hematoma Growth in Hyperacute Intracerebral Hemorrhage in Mice. Stroke 2023; 54:2640-2651. [PMID: 37610105 PMCID: PMC10530404 DOI: 10.1161/strokeaha.123.042632] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/02/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Spreading depolarizations (SDs) occur in all types of brain injury and may be associated with detrimental effects in ischemic stroke and subarachnoid hemorrhage. While rapid hematoma growth during intracerebral hemorrhage triggers SDs, their role in intracerebral hemorrhage is unknown. METHODS We used intrinsic optical signal and laser speckle imaging, combined with electrocorticography, to investigate the effects of SD on hematoma growth during the hyperacute phase (0-4 hours) after intracortical collagenase injection in mice. Hematoma expansion, SDs, and cerebral blood flow were simultaneously monitored under normotensive and hypertensive conditions. RESULTS Spontaneous SDs erupted from the vicinity of the hematoma during rapid hematoma growth. We found that hematoma growth slowed down by >60% immediately after an SD. This effect was even stronger in hypertensive animals with faster hematoma growth. To establish causation, we exogenously induced SDs (every 30 minutes) at a remote site by topical potassium chloride application and found reduced hematoma growth rate and final hemorrhage volume (18.2±5.8 versus 10.7±4.1 mm3). Analysis of cerebral blood flow using laser speckle flowmetry revealed that suppression of hematoma growth by spontaneous or induced SDs coincided and correlated with the characteristic oligemia in the wake of SD, implicating the vasoconstrictive effect of SD as one potential mechanism of action. CONCLUSIONS Our findings reveal that SDs limit hematoma growth during the early hours of intracerebral hemorrhage and decrease final hematoma volume.
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Affiliation(s)
- Paul Fischer
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129 Massachusetts, USA
- Klinik und Hochschulambulanz für Neurologie, Charité Universitätsmedizin Berlin, NeuroCure Excellence Cluster and Center for Stroke Research, 10117 Berlin, Germany
| | - Isra Tamim
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129 Massachusetts, USA
- Klinik und Hochschulambulanz für Neurologie, Charité Universitätsmedizin Berlin, NeuroCure Excellence Cluster and Center for Stroke Research, 10117 Berlin, Germany
| | - Kazutaka Sugimoto
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129 Massachusetts, USA
| | - Andreia Morais
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129 Massachusetts, USA
| | - Takahiko Imai
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129 Massachusetts, USA
| | - Tsubasa Takizawa
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129 Massachusetts, USA
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Tao Qin
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129 Massachusetts, USA
| | - Frieder Schlunk
- Department of Neuroradiology, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Matthias Endres
- Klinik und Hochschulambulanz für Neurologie, Charité Universitätsmedizin Berlin, NeuroCure Excellence Cluster and Center for Stroke Research, 10117 Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), partner site 10117 Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), partner site 10117 Berlin, Germany
| | - Mohammad A. Yaseen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129 Massachusetts, USA
| | - David Y. Chung
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129 Massachusetts, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, 02114 Massachusetts, USA
| | - Sava Sakadzic
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129 Massachusetts, USA
| | - Cenk Ayata
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129 Massachusetts, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, 02114 Massachusetts, USA
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Ezzy M, Alameer E. Predictors and Preventive Strategies of Bleeding After Thyroid Surgery. Cureus 2023; 15:e47575. [PMID: 38021981 PMCID: PMC10666654 DOI: 10.7759/cureus.47575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Postoperative compressive neck hematoma occurs in approximately 0.1% to 1.7% of cases, most occurring within the first six hours after surgery. Thyroid pathology, patient predisposition, and surgical technique are major risk factors for postoperative hematoma. This narrative review describes current perspectives on predicting and preventing bleeding following thyroid surgery. Predictors of bleeding after thyroid surgery include patient-related factors such as male sex and age, surgery-related factors like total thyroidectomy and operations for thyroid malignancy, and surgeon-related factors. Hemostasis is the primary focus after preserving critical structures in thyroid surgery. The clamp-and-tie technique has been the standard method for dividing the thyroid gland's main vascular pedicles for many years. Bipolar electrocautery has been used for vessels of small size. However, advanced bipolar and ultrasound energy and hybrid devices are now available options that may reduce operative time without increasing costs or complications. In cases where small bleeders close to critical structures are present and the clamp-and-tie technique is not feasible, hemostatic agents are commonly used. Drains do not appear to provide any significant benefits in preventing the sequelae of bleeding after thyroid surgery.
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Affiliation(s)
- Mohsen Ezzy
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
| | - Ehab Alameer
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
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Wei W, Yang L, Zhu Y, Liu C, Zhao Y. Massive Hemorrhage Following Acupuncture Treatment in a Neurofibromatosis Type 1 Patient. Cureus 2023; 15:e47825. [PMID: 38022201 PMCID: PMC10676751 DOI: 10.7759/cureus.47825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Neurofibromatosis type 1 (NF1) is a genetic disorder involving multiple organs. Vascular involvement is a rare complication among NF1 patients. We report a case of a 59-year-old female NF1 patient who presented with a massive hematoma over the scapular area after undergoing acupuncture treatment. Contrast-enhanced CT and MRI demonstrated a slightly hyperdense mass measuring 24.2 × 10.3 cm in size, and multiple enlarged and tortuous malformed vessels were seen arising from the left subclavian artery. Arterial embolization and subsequent surgical mass resection were successfully performed. This case indicates that minor injuries such as acupuncture-related ones could cause severe hemorrhage in patients with vascular malformation related to NF1. Endovascular angiography and embolization proved to be effective in localizing the culprit vessel and stopping active bleeding in our patient.
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Affiliation(s)
- Wei Wei
- Division of Nephrology, Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, CHN
| | - Letian Yang
- Division of Nephrology, Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, CHN
| | - Yuyi Zhu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, CHN
| | - Caihong Liu
- Division of Nephrology, Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, CHN
| | - Yuliang Zhao
- Division of Nephrology, Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, CHN
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West T, Driver CN, D'Souza RS. Incidence of Neuraxial and Non-Neuraxial Hematoma Complications From Spinal Cord Stimulator Surgery: Systematic Review and Proportional Meta-Analysis. Neuromodulation 2023; 26:1328-1338. [PMID: 35985940 DOI: 10.1016/j.neurom.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/17/2022] [Accepted: 07/05/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The goal of this meta-analysis was to estimate the incidence of total hematomas, neuraxial hematomas, and non-neuraxial hematomas in patients who underwent temporary spinal cord stimulator (SCS) lead trial placement and permanent implantation of SCS leads and internal pulse generator (IPG). MATERIALS AND METHODS A comprehensive search was conducted of databases of any publications before October 21, 2021. Eligible study designs included randomized control trials and prospective or retrospective observational studies with more than ten patients. The primary outcome variables were the incidences of total hematomas, neuraxial hematomas, and non-neuraxial hematomas in patients with SCS. These dichotomous categorical outcomes were abstracted from studies after Freeman-Tukey arcsine square root transformation using random-effects meta-analysis (DerSimonian and Laird method). Pooled incidence rates and 95% CIs were calculated for each outcome variable. RESULTS A total of 40 studies met the inclusion criteria. Included in the neuraxial and non-neuraxial hematoma analyses were 4751 patients and 3862 patients, respectively. The pooled incidence of any hematoma in patients with SCS was 0.81% (95% CI, 0.45%-1.27%). The pooled incidence of neuraxial hematoma in patients with SCS was 0.32% (95% CI, 0.18%-0.50%). This included primarily epidural hematomas (11/4751) but also comprised an intracranial hemorrhage in a patient on enoxaparin bridge therapy from warfarin and one patient not on anticoagulation with an intracranial subdural hematoma that resulted in death. The pooled incidence of non-neuraxial hematomas in patients with SCS was 0.59% (95% CI, 0.29%-1.00%). CONCLUSION The overall incidence of hematomas in patients with temporary SCS trial lead placement and permanent SCS/IPG implantations is less than 1%. Furthermore, the incidence of neuraxial hematomas is less than 0.5%, which is of particular interest given the potential devastating consequences of this complication. The results of this study can be used to inform patients and implanting physicians on hematoma complications from SCS and highlight that the benefits of SCS outweigh the hematoma risks if anticoagulation is appropriately managed perioperatively.
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Affiliation(s)
- Tyler West
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - C Noelle Driver
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
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Szymanski K, Munabi N, Garcia M, Ray E. Delayed, dramatic breast swelling in a transgender woman: a case report. Sex Med 2023; 11:qfad054. [PMID: 38034089 PMCID: PMC10687328 DOI: 10.1093/sexmed/qfad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/12/2023] [Accepted: 09/21/2023] [Indexed: 12/02/2023] Open
Abstract
Background As the number of gender-affirming procedures performed in the United States increases, physicians caring for gender-nonconforming patients, regardless of practice location and focus, will likely encounter transgender women with breast implants. Increasingly, transgender women are seeking breast feminization. However, this population is less consistently receiving surveillance and routine breast care than cisgender women. Aim This report aims to add to the growing body of knowledge addressing breast augmentation complications in transgender women and to highlight disparities in healthcare. Methods A case of breast implant-associated seroma at our institution was analyzed through chart review. A literature review was conducted using PubMed to gather all articles discussing breast implant-associated fluid collections in transgender patients. Prior to publication of this report, a Waiver of Consent was granted by the E.R.'s Institutional Review Board for the study under which this article was prepared. Results Our patient was an African American transgender woman presenting initially at age 60 with significant asymmetry due to dramatic swelling of her left breast. The patient underwent bilateral breast augmentation outside of the United States 2 decades prior. The patient noted a gradual painless increase in her left breast size starting 3 years prior. She admitted that she was hesitant to seek a second opinion after being treated dismissively by another surgeon. Subsequent management included mammography and mirrored recommendations for late breast implant-associated seromas in cisgender patients: ultrasound, aspiration for cytology and culture, and removal of the implant and capsule. Outcomes The fluid collection in our patient was determined to be a chronic hematoma and was managed surgically. Though this patient eventually achieved a good outcome, treatment was delayed due to barriers she faced as a transgender woman. Clinical Implications Literature demonstrates that recommended management of late-onset breast-implant-associated seroma does not differ based on gender identity; however, transgender and GNC adults are more likely to receive less thorough care than cisgender women. Any patients undergoing breast augmentation with implants should be routinely evaluated for late complications, including seromas, which require prompt attention and methodical evaluation due to their potentially malignant nature. Strengths and Limitations This article is limited in that it is a single report of breast seroma. It is strengthened by a PubMed review gathering all articles discussing breast-implant-associated fluid collections in transgender patients. Conclusion We propose better education of physicians on how to care for transgender and gender-diverse patients should help mitigate the neglect and late presentation of such medical conditions in this vulnerable and marginalized population.
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Affiliation(s)
- Kathryn Szymanski
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Naikhoba Munabi
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States
| | - Maurice Garcia
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
- Transgender Surgery and Health Program, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Edward Ray
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
- Transgender Surgery and Health Program, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
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Dhillon D, Moynihan HV, Santoro G, Lien K, Dayan MJ. A Rare Case of Post-orchidectomy Arterial Injury With Rapidly Enlarging Scrotal Hematoma Treated With Coil Embolization. Cureus 2023; 15:e47914. [PMID: 38034169 PMCID: PMC10683932 DOI: 10.7759/cureus.47914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2023] [Indexed: 12/02/2023] Open
Abstract
Testicular cancer is the most common solid tumor in young adult males. Radical inguinal orchidectomy is the gold standard for the diagnosis and treatment of testicular cancer, which is confined to the scrotum and is generally well tolerated. An uncommon, but known, complication of radical orchidectomy is scrotal hematoma. Scrotal hematoma from radical orchidectomy is commonly self-limited and typically self-resolving. We present a rare case of metastatic testicular malignancy diagnosed with radical inguinal orchidectomy complicated by a rapidly enlarging scrotal hematoma, successfully treated with surgical evacuation and image-guided arterial embolization.
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Affiliation(s)
- Diljot Dhillon
- Interventional Radiology, Zucker School of Medicine at Hofstra/Northwell at Mather Hospital, Port Jefferson, USA
| | - Harrison V Moynihan
- Interventional Radiology, Zucker School of Medicine at Hofstra/Northwell at Mather Hospital, Port Jefferson, USA
| | - Giovanni Santoro
- Interventional Radiology, Zucker School of Medicine at Hofstra/Northwell at Mather Hospital, Port Jefferson, USA
| | - Kenny Lien
- Interventional Radiology, Zucker School of Medicine at Hofstra/Northwell at Mather Hospital, Port Jefferson, USA
| | - Michael J Dayan
- Interventional Radiology, Zucker School of Medicine at Hofstra/Northwell at Mather Hospital, Port Jefferson, USA
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Reichman MB, McMahon P, Dwyer M, Chang SJ, Lin H, Katzen J, Thomas C, Drotman MB, Dodelzon K. Bleeding Events After Image-Guided Breast Biopsies: Comparison of Patients Temporarily Discontinuing Versus Maintaining Antithrombotic Therapy During Biopsy. AJR Am J Roentgenol 2023; 221:438-449. [PMID: 37162038 DOI: 10.2214/ajr.23.29164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND. Antithrombic (AT) therapy is commonly temporarily discontinued before breast core needle biopsy (CNB), introducing risks of thrombotic events and diagnostic delay. OBJECTIVE. The purpose of this article was to compare the frequency of postbiopsy bleeding events among patients without AT use, patients temporarily discontinuing AT therapy, and patients maintaining AT therapy during breast CNB. METHODS. This retrospective study included 5302 patients (median age, 52 years) who underwent image-guided breast or axillary CNB between January 1, 2014, and December 31, 2019. From January 1, 2014, to December 31, 2016, patients temporarily discontinued all AT therapy for 5 days before CNB; from January 1, 2017, to December 31, 2019, patients maintained AT therapy during CNB. Immediate postbiopsy mammograms were reviewed for imaging-apparent hematoma. Patients were called 24-48 hours after biopsy and asked regarding palpable hematoma and breast bruise. The EMR was reviewed for clinically significant postbiopsy hematoma (i.e., hematoma requiring drainage, primary care or emergency department visit for persistent symptoms, or hospital admission). Bleeding events were compared among groups, including Firth bias-reduced multivariable logistic regression analysis. RESULTS. During CNB, 4665 patients were not receiving AT therapy, 423 temporarily discontinued AT therapy, and 214 maintained AT therapy. Imaging-apparent hematoma occurred in 3% of patients without AT use, 6% of patients discontinuing AT therapy, and 7% of patients maintaining AT therapy (p = .60 [discontinuing vs maintaining]). Palpable hematoma occurred in 2% of patients without AT use, 4% of patients maintaining AT therapy, and 4% of patients discontinuing AT therapy (p = .92 [discontinuing vs maintaining]). Breast bruise occurred in 2% of patients without AT use, 1% of patients discontinuing AT therapy, and 6% of patients maintaining AT therapy (p < .001 [discontinuing vs maintaining]). In multivariable analysis adjusting for age, biopsy imaging modality, needle gauge, number of biopsy samples, and pathologic result, discontinued AT therapy (using maintained AT therapy as reference) was not a significant independent predictor of imaging-apparent hematoma (p = .23) or palpable hematoma (p = .91) but independently predicted decreased risk of bruise (OR = 0.11, p < .001). No patient developed clinically significant postbiopsy hematoma. CONCLUSION. Frequencies of imaging-apparent and palpable hematoma were not significantly different between patients temporarily discontinuing versus maintaining AT therapy. CLINICAL IMPACT. The findings support the safety of continuing AT therapy during CNB. Patients who maintain AT therapy should be counseled regarding risk of bruise.
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Affiliation(s)
- Melissa B Reichman
- Department of Radiology, Weill Cornell Medicine at New York-Presbyterian Hospital, 525 E 68th St, New York, NY 10065
| | | | | | | | | | - Janine Katzen
- Department of Radiology, Weill Cornell Medicine at New York-Presbyterian Hospital, 525 E 68th St, New York, NY 10065
| | - Charlene Thomas
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Michele B Drotman
- Department of Radiology, Weill Cornell Medicine at New York-Presbyterian Hospital, 525 E 68th St, New York, NY 10065
| | - Katerina Dodelzon
- Department of Radiology, Weill Cornell Medicine at New York-Presbyterian Hospital, 525 E 68th St, New York, NY 10065
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Foppen M, Bandral HV, Slot KAM, Vandertop WP, Verbaan D. Success of conservative therapy for chronic subdural hematoma patients: a systematic review. Front Neurol 2023; 14:1249332. [PMID: 37780712 PMCID: PMC10540204 DOI: 10.3389/fneur.2023.1249332] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Background Conservative therapy for chronic subdural hematoma (cSDH) is an option for patients who express no, or only mild symptoms, thereby preventing surgery in some. Because it is not clear for whom conservative therapy is successful, we aimed to estimate the success rate of conservative therapy and to identify which factors might influence success. Methods We systematically searched MEDLINE and EMBASE databases to identify all available publications reporting outcome of conservative therapy for cSDH patients. Studies containing >10 patients were included. The primary outcome was the success rate of conservative therapy, defined as "no crossover to surgery" during follow-up. In addition, factors possibly associated with success of conservative therapy were explored. Bias assessment was performed with the Newcastle Ottowa Scale and the Cochrane risk-of-bias tool. We calculated pooled incidence and mean estimates, along with their 95% confidence intervals (CIs), using OpenMeta[Analyst] software. Results The search yielded 1,570 articles, of which 11 were included in this study, describing 1,019 conservatively treated patients. The pooled success rate of conservative therapy was 66% (95% CI: 50-82%). One study (n = 98) reported smaller hematoma volume to be associated with success, whilst another study (n = 53) reported low hematoma density and absence of paresis at diagnosis to be associated with success. Conclusion Conservative therapy is reported to be successful in the majority of cSDH patients who have either no, or only mild symptoms. Hematoma volume, low hematoma density and absence of paresis could be factors associated with success. However, further research is warranted in order to establish factors consistently associated with a successful conservative therapy. Other No funding was acquired for this study. The study was not registered nor was a study protocol prepared.
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Affiliation(s)
- M. Foppen
- Department of Neurosurgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, Netherlands
| | - Harssh Verdan Bandral
- Department of Neurosurgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, Netherlands
| | - Kari-Anne Mariam Slot
- Department of Neurosurgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, Netherlands
| | - W. P. Vandertop
- Department of Neurosurgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, Netherlands
| | - D. Verbaan
- Department of Neurosurgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, Netherlands
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Dokuzović S, Španić M, Muthu S, Pavešić J, Ivandić S, Eder G, Bošnjak B, Prodan K, Lončar Z, Ćorluka S. Conservative Treatment for Spontaneous Resolution of Postoperative Symptomatic Thoracic Spinal Epidural Hematoma-A Case Report. Medicina (Kaunas) 2023; 59:1590. [PMID: 37763709 PMCID: PMC10534765 DOI: 10.3390/medicina59091590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023]
Abstract
Introduction: Postoperative epidural hematomas of the cervical and thoracic spine can pose a great risk of rapid neurological impairment and sometimes require immediate decompressive surgery. Case Report: We present the case of a young patient operated on for stabilization of a two-level thoracic vertebra fracture who developed total paralysis due to an epidural hematoma postoperatively. The course of epidural hematoma was quickly reversed with the help of a conservative technique that prevented revision surgery. The patient regained complete neurologic function very rapidly, and has been well on every follow-up to date. Conclusion: There is a role of similar maneuvers as described in this case to be employed in the management of postoperative epidural hematomas. However, prolonged watchful waiting should still be discouraged, and patients should remain ready for revision surgery if there are no early signs of rapid recovery.
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Affiliation(s)
- Stjepan Dokuzović
- Spinal Surgery Division, Department of Traumatology, University Hospital Center Sestre Milosrdnice, 10000 Zagreb, Croatia; (S.D.); (J.P.)
- Akromion Special Hospital for Orthopaedic Surgery, 49217 Krapinske Toplice, Croatia;
| | - Mario Španić
- Akromion Special Hospital for Orthopaedic Surgery, 49217 Krapinske Toplice, Croatia;
| | - Sathish Muthu
- Orthopaedic Research Group, Coimbatore 641045, Tamil Nadu, India;
- Department of Biotechnology, Faculty of Engineering, Karpagam Academy of Higher Education, Coimbatore 641021, Tamil Nadu, India
- Department of Orthopaedics, Government Medical College, Karur 639004, Tamil Nadu, India
| | - Jure Pavešić
- Spinal Surgery Division, Department of Traumatology, University Hospital Center Sestre Milosrdnice, 10000 Zagreb, Croatia; (S.D.); (J.P.)
| | - Stjepan Ivandić
- Traumatology Department, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia; (S.I.); (G.E.)
| | - Gregor Eder
- Traumatology Department, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia; (S.I.); (G.E.)
| | - Bogdan Bošnjak
- General Hospital, Croatian Veterans, 49210 Zabok, Croatia;
| | - Ksenija Prodan
- Clinical Department of Diagnostic and Interventional Radiology, Department of Traumatology, University Hospital Center Sestre Milosrdnice, 10000 Zagreb, Croatia;
| | - Zoran Lončar
- Anesthesiology, Intensive Care and Pain Management Division, Traumatology Department, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia;
| | - Stipe Ćorluka
- Spinal Surgery Division, Department of Traumatology, University Hospital Center Sestre Milosrdnice, 10000 Zagreb, Croatia; (S.D.); (J.P.)
- St. Catherine Specialty Hospital, 10000 Zagreb, Croatia
- Department of Anatomy and Physiology, University of Applied Health Sciences, 10000 Zagreb, Croatia
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