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Background and aims: Methods for femoral venous haemostasis following electrophysiology (EP) procedures include manual compression (MC) and suture‐based techniques such as a figure‐of‐eight suture secured with a hand‐tied knot (Fo8HT) or a modified figure‐of‐eight suture secured with a 3‐way stopcock (Fo8MOD). We hypothesised that short‐term bleeding outcomes using the Fo8MOD approach would be superior to MC. We additionally compared outcomes between Fo8MOD and Fo8HT approaches. Methods: We studied consecutive patients undergoing EP procedures at our institution between March and December 2023. Patients were categorised into three haemostasis groups: MC, Fo8HT and Fo8MOD. Access site complications were classified as major (requiring intervention or blood transfusion, delaying discharge or resulting in death) or minor (bleeding/haematoma requiring additional compression). Results: 1089 patients were included: MC 718 (65.9%); Fo8HT 105 (9.6%); Fo8MOD 266 (24.4%). Procedures were most commonly for atrial fibrillation (52.4%), atrial flutter (10.9%), and atrioventricular nodal re‐entrant tachycardia (10.1%). In patients receiving periprocedural anticoagulation (865, 79.4%), Fo8MOD associated with fewer complications than MC or Fo8HT (major: MC 2.2%, Fo8HT 6.0%, Fo8MOD 0.8%, p =.01; minor: MC 16.5%, Fo8HT 12.0%, Fo8MOD 7.4%, p =.002). In patients not receiving periprocedural anticoagulation, complications did not differ between haemostasis methods (total major and minor complications 5.8%, p =.729 for between groups rates). On multivariable logistic regression, Fo8MOD was associated with a significantly lower risk of access site complications (OR 0.29 [95% CI 0.17–0.48], p <.001), whilst intraprocedural heparinisation (OR 5.25 [2.88–9.69], p <.001) and larger maximal sheath size (OR 1.06 [1.00–1.11], p =.04) were associated with a higher risk of complications. Conclusion: Femoral haemostasis with Fo8MOD associates with fewer access site complications than MC and Fo8HT following EP procedures that need periprocedural anticoagulation. [ABSTRACT FROM AUTHOR]

Background/Objectives: MMA embolisation has emerged in recent years as a safe endovascular treatment for chronic subdural haematoma. We report the first UK series of endovascular treatment of chronic subdural haematomas. Design: Prospective case series. Subjects: All adult patients referred with midline shift ≤10 mm and GCS ≥13 were considered. Patients had to be mobile with a standard origin of Middle Meningeal and Ophthalmic arteries. Patients with GCS < 13 or profound weakness (MRC grade ≤ 3) were treated with burr hole drainage and placement of subdural drains. Methods: Patients were recruited over a 14-month period from 25 October 2020 to 25 December 21 through our electronic referral system. Patients' demographics, pre-morbid modified Rankin Score (mRS), symptoms; anticoagulation and co-morbidities were prospectively collected. Suitability for endovascular treatment was discussed with the interventional neuroradiologist and neurosurgeon. SQUID-12 embolic material was used for all MMA embolisations, which was performed under general anaesthetic. Baseline CT/MRI characteristics were collected. Further imaging was obtained at 7, 21, 90 and 180 days. Clinical assessment and mRS was completed at three months. Results: Fifteen patients underwent endovascular embolisation of MMA in the study period. Of these 13 were male, median age was 79 years. Median length of stay was four days. Follow-up CT at three months has demonstrated significant reduction in both midline shift (p = 0.002) and maximum thickness of haematoma (p = 0.001). Nine patients had reached the three months' follow-up period. All of them had complete or near-complete resolution of the CSDH. One patient required surgical rescue at two months post procedure due to progression of CSDH. We report one mortality due to COVID-19. Conclusions: For select patients, MMA embolisation is a safe alternative treatment option for chronic subdural haematoma. As we gain more experience, the procedure could be performed under local anaesthetic. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to find out if patients can travel safely on a plane 48 hours after open septo-rhinoplasty (SRP) surgery. Also, to compare analgesic need, mobilization time, readmission rate, side effects, time out of work and routine life between travelling and nontravellingpatients. Materials and Methods: This study was conducted at Istanbul Florence Nightingale Hospitals in Istanbul/Turkey and Group Florence Hospitals in London/United Kingdom. A total of 120 patients who had SRP were included in the study. Sixty patients who traveled from London to Istanbul by plane (approximately 3 hours 40 minutes, 2520 km) for SRP surgery and returned home 48 hours after surgery were compared with 60 local patients. All patients were observed at 8, 12, 24, 36, and 48 hour intervals after surgery. Additionally, all patients who travelled from London to Istanbul were reviewed after 6 days, 14 days, 1 month, 3 months, 6 months and 1 year. The analgesia need, mobilization time, readmission rate, early and late complications patterns and incidence, time out of work and daily routine was compared between the two groups. Early onset side effects include pain, discomfort, bruising, ecchymosis, edema, oozing, bleeding, septal haematoma, and late onset complications like delayed septal haematoma, delayed bleeding, infection, excess edema, breathing problems were compared between travelling and nontravelling patients. Results: The hospital stay was 24 hours for all patients. No further analgesia was needed in both groups during their hospital stay, Mobilization time was in 8 hours in both groups and none of the patients needed readmission in both groups. Common early complications in travelling patients like pain, edema, bruising, ecchymosis, minor oozing, blocked nose, and pain after 48 hours were similar to the local patients and all travelling patients felt confident and strong enough to travel after 48 hours without additional medication or treatment during or after the surgery. Conclusion: People with no underlying medical conditions, who want to travel abroad for surgery and cannot or do not want to stay longer than 48 hours due to their personal or business lives, can consider travelling back to their countries, following SRP surgery, which is as safe as having the surgery locally without travelling abroad. [ABSTRACT FROM AUTHOR]

Achenbach’s syndrome describes the sudden occurrence of bruising, pain and swelling of one or more digits of the hand involving the volar aspect of the proximal and middle phalanges. Also known as the paroxysmal finger hematoma, it presents in dramatic fashion, sometimes with a prodrome of tingling, itching or numbness but despite its dramatic presentation, all investigations are normal. Routine blood investigations, as well as coagulation and thrombophilia screens are all negative as are vascular imaging and echocardiography. The diagnosis is solely clinical. Due to the nature of its presentation, almost all patients are referred for an urgent vascular consultation but the condition resolves spontaneously usually within 2â€" 3 days, although the discoloration may persist for longer. Its appearance usually leads clinicians to start anticoagulation in the belief that it may progress but, in fact, it settles as quickly as it appears. Though there are episodic cases which recur years later, it is generally self-resolving with no complications nor residual morbidity. Although the etiology was previously unknown, there is now a recognized genetic link. Genes related to the acute phase reactive proteins and the coagulation and complement cascades appear to be linked to Achenbach’s syndrome. This evidence may explain why only certain individuals seem prone to this acutely painful, bruising disorder. We review this interesting disorder and compare patients from the tropical Caribbean region with similar cases from the temperate United Kingdom and discuss whether there are climatic variations in presentations. [ABSTRACT FROM AUTHOR]

To evaluate the incidence and risk factors for aural haematoma in dogs under primary veterinary care in the UK. A cohort study design. Dogs diagnosed with aural haematoma during 2016 were identified from the VetCompass database. Univariable and multivariable logistic regression modelling were used for risk factor analysis. There were 2,249/905,554 dogs diagnosed with aural haematoma during 2016. The estimated one-year incidence risk for aural haematoma was 0.25% (95% confidence interval 0.24–0.26). After accounting for confounding factors, 14 breeds showed increased odds and 20 breeds showed reduced odds of aural haematoma compared with crossbred dogs. Breeds with the highest odds included Bull Terrier (OR 7.42, 95% confidence interval 4.39–12.54), Saint Bernard (OR 7.28, 95% confidence interval 3.58–14.81) and French Bulldog (OR 6.95, 95% confidence interval 5.55–8.70). Increasing age, increasing bodyweight and breeds with V-shaped drop and semi-erect ear carriage also showed increased odds of aural haematoma. Associations between ear carriage within breeds and the risk of aural haematoma suggest that trauma along the line of cartilage folding within V-shaped and semi-erect ears may trigger aural haematoma. New knowledge of key breed predispositions will contribute to improved breed health control strategies. [ABSTRACT FROM AUTHOR]

Background: The incidence of chronic subdural haematoma (CSDH) is increasing. Although surgery remains the mainstay of management for symptomatic patients, uncertainty remains regarding the role of steroids. Hence, the Dex-CSDH trial was launched in the UK in 2015 aiming to determine whether, compared to placebo, dexamethasone can improve the 6-month functional outcome of patients with symptomatic CSDH by reducing the rate of surgical intervention and recurrence rate.Methods and Design: Dex-CSDH is a multi-centre, pragmatic, parallel group, double-blind, randomised trial assessing the clinical utility of a 2-week course of dexamethasone following a CSDH. Seven hundred fifty patients were randomised to either dexamethasone or placebo. The primary outcome is the modified Rankin Scale at 6 months which is dichotomised to favourable (a score of 0-3) versus unfavourable (a score of 4-6).Conclusions: This paper and the accompanying additional material describe the statistical analysis plan for the trial.Trial Registration: ISRCTN, ISRCTN80782810. Registered on 7 November 2014. http://www.isrctn.com/ISRCTN80782810. EudraCT, 2014-004948-35. Registered on 20 March 2015. [ABSTRACT FROM AUTHOR]

Purpose: Categorize data to investigate the surgeon volume outcome relationship in thyroidectomies. Determine the evidence base for recommending a minimum number of thyroidectomies performed per year to maintain surgical competency. Methods: Data on thyroid operations in the United Kingdom Registry of Endocrine and Thyroid Surgery (UKRETS) from 01/09/2010 to 31/08/2016 was analysed. The primary outcome measure was permanent hypoparathyroidism (PH). Recurrent laryngeal nerve palsy (RLN) and post-operative haematoma were also examined. Exclusion criteria included patient age > 85 or < 18 years, and surgeons contributing <10 operations. Data analysis was performed using general additive models and mixed effect logistic regression for PH and binary logistic regression for others. Results: For PH 10313 bilateral thyroid operations were analysed. The Annual rate (AR, p = 0.012) and nodal dissection (P < 10−7) were significant factors. 25,038 thyroidectomies were analysed to investigate the effect of surgeon Volume on RLN palsy and haematoma. Age, retrosternal goitre, routine laryngoscopy, re-operation, nodal Dissection, bilateral thyroidectomy, RLN monitoring and surgeon volume were significantly associated with RLN palsy. Post-operative haematoma showed no significant correlation to surgeon volume. Categorisation of AR showed that PH and RLN palsy rates declined in surgeons performing >50 cases/year to a minimum of 3% and 2.6% respectively in highest volume AR group (>100 cases/year). Conclusion: Surgeon annual operative volume is a factor in determining outcome from thyroid surgery. Results are limited by a high proportion of missing data, which could potentially bias the outcome, but tentatively suggests the minimum recommended number of thyroid operations / year should be 50 cases. [ABSTRACT FROM AUTHOR]

Purpose: To review the management of patients >16 years with blunt splenic injury in a single, UK, major trauma centre and identify whether the following are associated with success or failure of non-operative management with selective use of arterial embolization (NOM ± AE): age, Injury Severity Score (ISS), head injury, haemodynamic instability, massive transfusion, radiological hard signs [contrast extravasation or pseudoaneurysm on the initial computed tomography (CT) scan], grade, and presence of intraparenchymal haematoma or splenic laceration.Methods: Retrospective, cross-sectional study undertaken between April 2012 and October 2015. Paediatric patients, penetrating splenic trauma, and iatrogenic injuries were excluded. Follow-up was for at least 30 days.Results: 154 patients were included. Median age was 38 years, 77.3% were male, and median ISS was 22. 14/87 (16.1%) patients re-bled following NOM in a median of 2.3 days (IQR 0.8-3.6 days). 8/28 (28.6%) patients re-bled following AE in a median of 2.0 days (IQR 1.3-3.7 days). Grade III-V injuries are a significant predictor of the failure of NOM ± AE (OR 15.6, 95% CI 3.1-78.9, p = 0.001). No grade I injuries and only 3.3% grade II injuries re-bled following NOM ± AE. Age ≥55 years, ISS, radiological hard signs, and haemodynamic instability are not significant predictors of the failure of NOM ± AE, but an intraparenchymal or subcapsular haematoma increases the likelihood of failure 11-fold (OR 10.9, 95% CI 2.2-55.1, p = 0.004).Conclusions: Higher grade injuries (III-V) and intraparenchymal or subcapsular haematomas are associated with a higher failure rate of NOM ± AE and should be managed more aggressively. Grade I and II injuries can be discharged after 24 h with appropriate advice. [ABSTRACT FROM AUTHOR]

Purpose: Previous reports have suggested higher periprocedural complications after ipsilateral antegrade femoral arterial access (AA). We looked at a contemporary series comparing complication rates between AA and contralateral retrograde femoral arterial access (RA) for femoropopliteal angioplasty. Method: A prospective review of all cases between 2010 and 2015 in a United Kingdom tertiary vascular center. Demographical and procedural data were obtained for those undergoing percutaneous femoropopliteal angioplasty. The primary outcome looked at periprocedural complications including retroperitoneal hematoma, pseudoaneurysm, hematoma requiring transfusion, arteriovenous fistulation, and surgical intervention. Secondary outcomes included contrast and radiation doses in addition to procedural failure leading to major amputation. Results: A total of 556 (66% male) patients underwent femoropopliteal angioplasty, 461 (82%) via AA. Groups were of comparable age, sex, comorbidity, and symptomatology. AA patients had a lower body mass index, 26 versus 29 (P = .005). No significant difference was seen in periprocedural (15.8% AA vs 11.6% RA; P = 0.292) or access site complications (3.7% AA vs 1.1% RA; P = 0.186). There was less need for a closure device, 40.3% AA vs 73% RA (P < .01), less contrast, 94 mL AA: 114 mL RA (P < .001), and less radiation, 3487 cGy cm2 AA: 9697 cGy cm2 RA (P < .001). Arterial access was also associated with greater technical success of 83.8%: 73.3% RA (P = .002). Conclusions: Arterial access is associated with higher technical success and reduced contrast/radiation doses with no significant difference in complications compared to RA contrary to previous reports. [ABSTRACT FROM AUTHOR]

Object. Significant haemorrhage following intracranial tumour resection may occur in 1-2% of cases and the majority occur within the first few hours post-operatively. Implantation of carmustine wafers has been associated with increased operative site complications in some series, but post-operative haematoma is not routinely reported. We analyzed the characteristics of post-operative haemorrhage after carmustine wafer insertion. Methods. We performed a retrospective audit of surgical site haematoma after tumour resection and insertion of carmustine wafers in two neurosurgical units in the UK (University Hospital of North Staffordshire, Stoke-on-Trent, March 2003 - July 2012; Wessex Neurological Centre, Southampton, October 2005 - January 2013). Results. During the specified time periods, carmustine wafers were inserted in 181 operations in 177 patients. We identified acute operative site haematomas after carmustine wafer insertion in 8 (4.4%) patients. All presented in a delayed fashion on or after Day 2 post-operatively. In contrast, acute operative site haematoma was present in 4/491 (0.81%) of patients who underwent resection without gliadel wafer insertion. Conclusions. In contrast to the expected timing of bleeding following intracranial tumour resection, all carmustine wafer patients who experienced haemorrhage presented in a delayed fashion on or after Day 2 post-operatively. The causative factors for universally delayed post-operative haematoma after carmustine wafer insertion are unclear and further studies are required to characterize this phenomenon. [ABSTRACT FROM AUTHOR]

Background. Chronic subdural haematoma (CSDH) is a common condition that increases in incidence with rising age. Evacuation of a CSDH is one of the commonest neurosurgical procedures; however the optimal peri-operative management, surgical technique, post-operative care and the role of adjuvant therapies remain controversial. Aim. We propose a prospective multi-centre audit in order to establish current practices, outcomes and national benchmarks for future studies. Methods. Neurosurgical units (NSU) in the United Kingdom and Ireland will be invited to enrol patients to this audit. All adult patients aged 16 years and over with a primary or recurrent CSDH will be eligible for inclusion. Outcome measures and analysis. The proposed outcome measures are (1) clinical recurrence requiring re-operation within 60 days; (2) modified Rankin scale (mRS) score at discharge from NSU; (3) morbidity and mortality in the NSU; (4) destination at discharge from NSU and (5) length of stay in the NSU. Audit standards have been derived from published systematic reviews and a recent randomised trial. The proposed standards are clinical recurrence rate < 20%; unfavourable mRS (4-6) at discharge from NSU < 30%; mortality rate in NSU < 5%; morbidity rate in NSU < 10%. Data will be submitted directly into a secure online database and analysed by the study's management group. Conclusions. The audit will determine the contemporary management and outcomes of patients with CSDH in the United Kingdom and Ireland. It will inform national guidelines, clinical practice and future studies in order to improve the outcome of patients with CSDH. [ABSTRACT FROM AUTHOR]

The article presents abstracts on medical topics including anaesthesia for acute abdomen in children by M. Ajmal, abdominal wall haematoma by F. J. Gerges and M. S. Shulman, and skill acquisition by anaesthetic trainees in practical procedures by S. E. Smith and V. R. Tallentire.

The article presents a study which investigated the effect of drains on recurrence rates and clinical outcomes among those patients with chronic subdural haematoma at one British center between November 2004 and November 2007. Chronic subdural haematoma is a disease associated with substantial morbidity and mortality. The study found that recurrence occurred in 9.3 percent people with drainage procedure and 24 percent without drainage. It was also found that the main reason why most neurosurgeons in Great Britain and Ireland preferred to avoid use of drains is the concern on heightened operative risk.

Investigates the issue of spinal hematoma following central neuraxial block in patients in Great Britain. Rareness of the incidence; Percentage of hematoma associated with concomitant use of anticoagulants; Description of the pharmacology of the newer and older anticoagulants.

Unsuccessful attempts were made to insert a thoracic epidural in an anaesthetised patient. Signs of spinal cord damage were observed the following day. Magnetic resonance imaging demonstrated a haematoma anterior to the spinal cord. Surgical exploration revealed an intradural haematoma and a needle puncture of the cord. The patient suffered a permanent paraparesis. [ABSTRACT FROM AUTHOR]

The article presents a case study of an 84-year-old woman with 1-month history of decreased appetite and unintentional weight loss who presented to emergency department following a collapse at her home. The patient showed prolonged activated partial thromboplastin time (APTT) and was diagnosed with acquired haemophilia A. One week following the diagnosis, she developed facial-swelling haematoma and passed away the following day. An overview of management of acquired haemophilia A is provided.

Examines costs and benefits of admission after mild head injury in hospitals in Great Britain. Increase in the incidence of head injury in the country; Policy on the admission of patients with history of unconsciousness of hematoma; Reliability of computed tomography in detecting intracranial hematomas.

The article presents the case of a 15-year-old male who was rushed to an emergency department due to a nasal injury sustained while playing rugby. He was referred to the ear, nose and throat department when an anterior rhinoscopy showed a bilateral cherry red swelling from his nasal septum. He underwent an emergency operation to drain his nasal septal haematoma. INSET: HOW COMMON ARE NASAL SEPTAL HAEMATOMAS?.

Reports on the ultrasonographic findings of a study performed in a beef cow with pulmonary hematoma in Great Britain. Causes of pulmonary hemorrhage in cattle; Clinical symptoms determined in the animals; Identification of an abnormal expiratory effort during respiration of cattle.

Focuses on the attitudes of orthopaedic surgeons in using thromboprophylaxis among patients in Great Britain. Recognition of deep venous thrombosis as a major problem in orthopaedic surgery; Types of prophylactic agents; Correlation between wound bleeding and hematoma.

A letter to the editor is presented which comments on the article "Proposal For a Prospective Multi-Centre Audit of Chronic Subdural Haematoma (CSDH) management in Great Britain and Ireland" by Ian C. Coulter, Angelos G. Kolias and Hani J. Marcus which evaluates the outcomes of CSDH treatment.