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Arthrocentesis of the temporomandibular joint (TMJ) is the unadorned form of surgical therapy which comprises of lavage of inflammatory enzymes and mediators and improve joint mobility and eliminate pain by pressure of the lavage solution in the upper compartment of TMJ. Objectives: The current study was conducted to assess and compare the effectiveness of arthrocentesis with normal saline alone and in conjunction with sodium hyaluronate (SH) injection in the treatment of internal derangement of the TMJ. Methodology: Sixty patients with internal derangement of the TMJ were randomly divided into two equal groups; Group 1 was performed with normal saline and Group 2 with normal saline followed by 1 ml of SH. The patients were followed up after 1 week to check for any postoperative complications and 1, 2, and 3 months for subsequent sessions and changes in subjective and objective variables. Results: The increase in mouth opening from preoperative to 3 months' postoperatively was 4.9 mm for Group 1 and 6.43 mm for Group 2. The change in the pain score (visual analogue scale scale) in Group 1 from the preoperative session to 3 months' follow-up was 7.23-4.1 and in Group 2 was 7.36-3.7. The difference in clicking/popping in Group 1 from preoperative session to 3 months' follow-up was 2.43-1 and in Group 2 was 2.4-0.53. Conclusion: Patients refractory to conservative treatment showed promising results with arthrocentesis with SH than arthrocentesis alone in treatment of TMJ internal derangement. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the differences in the expression of microRNA (miRNA) in lavage fluid of virtual navigation ultrasound bronchoscopy in patients with different types of lung cancer and the diagnostic efficacy in peripheral lung cancer (PLC), There were 65 patients with central lung cancer (CLC) (central group) and 65 patients with PLC (peripheral group) who were selected. The expressions of miR-1260b, miR-135a-3p, miR-299-3p, miR-3175 in lavage fluid were detected, as well as the expression of carcinoembryonic antigen (CEA) and neuron-specific enolase (NSE). The miR-1260b of the peripheral group was lower than that of the central group, and the miR-135a-3p and miR-3175 were higher than that of the central group (P<0.05). miR-1260b, miR-135a-3p, miR-3175 were related to CEA and NSE, and significantly related to PLC (P<0.05). The AUC of miR-1260b and miR-135a-3p combined diagnosis of PLC was higher than that of single diagnosis. The combined diagnosis efficiency of miR-1260b, miR-135a-3p, miR-299-3p, and miR-3175 was higher than any single one. Therefore, it can be seen that miR-1260b, miR-135a-3p, and miR-3175 in the lavage fluid of virtual navigation ultrasound bronchoscope for PLC and CLC patients are differentially expressed. Combined detection is of great value for the diagnosis of PLC. In addition, the combined detection of miR-1260b, miR-135a-3p, miR-299-3p, and miR-3175 can predict PLC metastasis and provide a basis for clinical diagnosis and treatment. [ABSTRACT FROM AUTHOR]

The aim of our manuscript is to illustrate the past, present and future role of rheumatologists performing arthroscopy. Doctors first began adapting endoscopes to inspect joints to assess synovial conditions that concern rheumatologists. Rheumatologists were among the pioneers developing arthroscopy. Students of the father of modern arthroscopy, Watanabe, included rheumatologists, who taught others once home. Rheumatologists assessed the intra-articular features of their common diseases in the 60s and 70s. Improvements in instrumentation and efforts by a few orthopaedists adapted a number of common joint surgical procedures for arthroscopy. Interest from rheumatologists in arthroscopy grew in the 90s with 'needle scopes' used in an office setting. Rheumatologists conducting the first prospective questioning arthroscopic debridement in OA and developing biological compounds reduced the call for arthroscopic interventions. The arthroscope has proven an excellent tool for viewing and sampling synovium, which continues to at several international centres. Some OA features—such as calcinosis—beg further arthroscopic investigation. A new generation of 'needle scopes' with far superior optics awaits future investigators. [ABSTRACT FROM AUTHOR]

Abstract Background The research objectives of the Femoroacetabular Impingement Randomised controlled Trial (FIRST) are to assess whether surgical correction of the hip impingement morphology (arthroscopic osteochondroplasty) with or without labral repair, in adults aged 18–50 years diagnosed with non-arthritic femoroacetabular impingement (FAI), provides decreased pain and improved health-related quality of life at 12 months compared to arthroscopic lavage of the hip joint. This article describes the statistical analysis plan for the FIRST trial. Methods/design FIRST is an ongoing multi-centre, blinded randomised controlled trial of 220 patients who have been diagnosed with FAI and are optimized for surgical intervention. This article describes the overall analysis principles, including how participants will be included in each analysis, the presentation of the results, adjustments for covariates, the primary and secondary outcomes and their respective analyses. In addition, we will present the planned sensitivity and subgroup analyses. Discussion Our rationale for FIRST is based upon (1) an epidemic of FAI surgery with resultant increased healthcare costs over that last decade, (2) worldwide disparity in perceptions about its utility, and (3) consensus that definitive evidence for or against surgical approaches is lacking. Trial registration ClinicalTrials.gov, NCT01623843. Registered on 20 June 2012.

Objective: To report our initial experience using the ultrasound (US)-guided single-needle lavage technique for treating calcific Achilles tendinitis. Methods: Eighteen patients with chronic ankle pain refractory to medical treatment were treated percutaneously using a fine needle lavage technique under US guidance. Patients were evaluated using the visual analogue scale (VAS) pain score both before and 3 months after the procedure. Treatment-related complications were also recorded. Results: All 18 cases of US-guided single-needle lavage were performed successfully. The range of recovery time was 30-45 days, and there was a significant reduction in the VAS pain score. Conclusion: The US-guided single-needle lavage technique seems to be an effective and minimally invasive way to treat calcific Achilles tendinitis.

The study was conducted in six calves presented with septic arthritis belonging to different age, breed and sex. Among the six calves, three were affected with chronic stage of disease with joint contracture and non-weight bearing on the affected limb. Clinical signs of arthritis were noticed in all the cases. Radiography and goniometry provided information regarding response to treatment protocol adapted. Haematology and serum biochemistry were found to have limited diagnostic value. Treatment protocol formulated which contains, three stage lavaging, application of splint and empirical antibiotic therapy showed satisfactory results. The progression of the evaluation of joint disorder, efficacy of the diagnostic modalities and standardisation of treatment protocol was attempted in this study

Background: Femoroacetabular impingement (FAI) is a condition known to cause hip pain in young adults. Purpose: To evaluate the efficacy of the surgical correction of FAI via arthroscopic osteochondroplasty with or without labral repair compared with arthroscopic lavage of the hip joint with or without labral repair. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 220 male and female participants aged 18 to 50 years with nonarthritic FAI suitable for surgical treatment were recruited for the trial at 10 clinical centers in Canada, Finland, and Denmark between October 2012 and November 2017, of whom 214 were included in the final analysis. In the osteochondroplasty group, cam- and/or pincer-type lesions were resected using fluoroscopic guidance. In the lavage group, the joint was washed out with 3 L of normal saline. Surgeons were instructed to repair the labrum in both groups if it was mechanically unstable once probed, showing visible displacement or chondrolabral separation. The primary outcome was patient-reported pain (using the 100-point visual analog scale [VAS]) at 12 months. Secondary outcomes included hip function (Hip Outcome Score [HOS] and International Hip Outcome Tool), physical and mental health (12-Item Short Form Health Survey), and health utility (EuroQol–5 Dimensions) at 12 months as well as any reoperations and other hip-related adverse events at 24 months. Results: At 12 months, there was no difference in pain (VAS) between the groups (mean difference [MD], 0.11 [95% CI, –7.22 to 7.45]; P =.98). Also, 88.3% (189/214) of participants had a labral tear, of which 60.3% were repaired. For the secondary outcomes, there were no significant differences between treatment groups, with the exception of the HOS activities of daily living domain in which lavage showed significant improvement compared with osteochondroplasty (MD, –5.03 [95% CI, −10.40 to −0.03]; P =.049). By 24 months, there were significantly fewer reoperations reported in the osteochondroplasty group (8/105) than the lavage group (19/104) (odds ratio, 0.37 [95% CI, 0.15-0.89]; P =.026). The primary reasons for a reoperation included hip pain (15/27; 55.6%) and a reinjury of the labrum (11/27; 40.7%). Conclusion: Both the osteochondroplasty and the lavage groups with or without labral repair for FAI had significantly improved pain or function significantly at 1 year. By 2 years, the reoperation rate was significantly lower in the osteochondroplasty group. Registration: NCT01623843 (ClinicalTrials.gov identifier) [ABSTRACT FROM AUTHOR]

Background: Gas conditioning minimizes complications associated with invasive ventilation of neonates. Poorly conditioned gas contributes to humidity deficit, facilitates condensate pools, and contributes to safety events. The specific aim was to objectively quantify the temperature drop across the unheated portion of a neonatal circuit and the impact condensation has to resistance to flow in the ventilator circuit. Methods: Ventilator circuits and filters were obtained, assembled according to manufacturer recommendations, and operational verification procedures were performed prior to data collection. A neonatal test lung was connected to each Servo-I ventilator with the following settings: pressure control IMV mode; inspiratory pressure: 14 cm H2O to achieve an exhaled tidal volume of 6.0 mL; PEEP: 5 cm H2O; pressure support: 5 cm H2O, FIO2: 0.21; set frequency 40/min; and inspiratory time: 0.4 s. The Fisher and Paykel MR850 and ChonchaTherm Neptune heaters were set at a temperature of 40°C. To evaluate both systems under similar conditions, the ChonchaTherm Neptune heater humidity control was set to midline. Heaters were turned on simultaneously and given 1 h to equilibrate. Readings for room temperature, airway temperature at the patient connection, airway resistance, exhaled tidal volume, and direct observation of circuit condensation and (or) pooling were recorded hourly for a 48-h period. Summary statistics were calculated for the variables of interest. Results: Mean (±SD) air temperature was 26.3°C (±1.4) for the Fisher & Paykel MR850 system and 26.2°C (±1.5), for the ChonchaTherm Neptune system. Mean (±SD) airway resistance was 229.3 cm H2O/L/s (±81.0) for the Fisher & Paykel system and 196.2 cm H2O/L/s (±39.4) for the ChonchaTherm Neptune system. Mean (±SD) tidal volume for the Fisher & Paykel MR850 system was 6.5 mL (±0.4), and for the ChonchaTherm Neptune system was 7.2 mL (±0.6). Conclusion: Circuit condensate increased tidal volume delivery and airway resistance. Temperature at the patient connection was lower than the temperature monitored by the system 12 inches distally, which can negatively impact gas conditioning. [ABSTRACT FROM AUTHOR]

To explore the immunoregulatory function of peony seed proteolysis product in mice, the protein from peony seed meal was extracted and hydrolyzed with bromelain. The peony seed proteolysis product was fed to mice at three different doses of 0.25, 0.5, and 1.0 g/kg for 21 days. The immunoregulation abilities of peony seed proteolysis product after each of these doses were evaluated in mice. Our results showed that all immune indices were higher in mice that had received a lavage with peony seed proteolysis product than in control mice. The immune indices of immune organs, delayed‐type hypersensitivity reaction (DTH), phagocytosis of peritoneal macrophages, serum hemolysin levels, lymphocyte proliferation (SI value), and levels of IFN‐γ and IL‐4 in the middle dose and high dose groups were significantly higher (p <.05) or extremely significant (p <.01) in comparison with the control group. These results indicate that the peony seed proteolysis product enhances immunological functions in mice. Practical applications: Peony seed is rich in proteins and can be extracted and hydrolyzed using bromelain. The peony seed proteolysis product can enhance the nonspecific, humoral, and cellular immune responses. Thus, peony seed could be of potential value to obtain peony seed protein, which can be further developed and utilized in the manufacture of functional health products. [ABSTRACT FROM AUTHOR]

Background: Dilute povidone-iodine (PI) lavage, a simple disinfection method, could reduce postoperative infection risk. However, there is no clinical consensus regarding its efficacy in total joint arthroplasties (TJAs). This systematic review and meta-analysis evaluated PI lavage's efficacy in preventing infection after TJA.Methods: MEDLINE, Embase, and the Cochrane Library were systematically searched for studies published before November 22, 2019, that compared postoperative infection rates in patients who underwent TJA with or without PI lavage before wound closure. Subgroup analyses were designed to identify the differences in infection site (overall or deep), type of surgery (total hip arthroplasty or total knee arthroplasty), time until diagnosis of infection (3 or 12 months postoperatively), and primary/aseptic revision arthroplasties.Results: We included 7 studies with 31,213 TJA cases, comprising 8861 patients who received PI lavage and 22,352 who did not. Pooled odds ratio for overall infection rate for the PI and non-PI lavage groups was 0.67 (95% confidence interval, 0.38-1.19, P = .17) and for the deep infection rate was 0.90 (95% confidence interval, 0.27-2.98, P = .86). Subgroup analyses revealed no differences in postoperative infection rates between the PI and non-PI lavage groups in terms of total hip arthroplasty and total knee arthroplasty, diagnosis of infection at 3 and 12 months postoperatively, or primary and aseptic revision arthroplasties.Conclusion: We detected no differences in the overall postoperative infection rates between the PI and non-PI lavage groups before wound closure in TJA including all studies in the subgroup analyses. [ABSTRACT FROM AUTHOR]

Introduction: In contrast to cemented hip prostheses, the effect of washing the bone bed with jet-lavage prior to insertion of cementless stem components in primary hip arthroplasty (THA) is unclear. Jet-lavage potentially decreases the risk of fat embolisation during rasping and stem insertion and might help in avoiding bacterial contamination. An earlier animal study has shown less debris and better-organised trabecular structure of new bone when jet-lavage was used. We hypothesised that the primary stability of cementless femoral stems implanted after jet-lavage of the femoral canal prior to stem insertion would improve with earlier stabilisation, as measured with Radiostereometry (RSA), compared with insertion without prior jet-lavage. Methods: 40 patients with primary osteoarthritis operated on with a cementless titanium grit blasted stem are included in the study. The patients were randomised to either jet-lavage or control without any lavage of the femoral canal prior to insertion of the prosthesis. The stem migration pattern was measured with RSA at 0, 3, 12, 24 and 72 months. Results: At 6 years, 19 patients remained for analysis in the jet-lavage and 18 in the control group. We found no difference in extent or pattern of migration as measured with RSA. Both groups seemed to have stabilised within 3 months after a slight subsidence and retroversion. No stem was revised or considered loose as measured with RSA. Conclusions: Washing the bone bed with jet-lavage prior to insertion of cementless stems does not affect the stability of cementless femoral components. No adverse effects were observed. [ABSTRACT FROM AUTHOR]

Purpose and objectives. Peritoneal complications of acute appendicitis are inevitable and require a firm attitude both in terms of reducing intraoperative risks but especially in choosing the appropriate therapeutic approach. Material and method. The paper presents a retrospective biostatistical study of appendicular peritonites operated laparoscopically in the General Surgery Clinic of “Sf. Ioan” Emergency Clinical Hospital of Bucharest between January 2008 and December 2016. Results. There were 1,275 cases with various forms of acute appendicitis, of which 278 (21.80%) were complicated forms. Among them, 94 cases (7.37%) presented generalized peritonitis with different degrees of severity and 184 (14.43%) cases were localized peritonitis. Generalized peritonitis of appendicular cause was operated laparoscopically in almost 71.27% of the cases (67 out of 94 generalized peritonitis of appendicular cause). The incidence of postoperative complications was significantly lower in the case of the laparoscopic approach of appendicular peritonitis (p < 0.0001), compared to conventional operations. Conclusions. The indications and limits of the laparoscopic approach in the treatment of appendicular peritonitis are largely dictated by the severity of the lesions, but the experience of the operating team also has an important role. [ABSTRACT FROM AUTHOR]

This study was performed to test a protocol for trans-implant treatment of chronic recurrent maxillary sinusitis (CRS), via implants with an internal removable sealing screw. The appropriate indications for treatment, optimal number of treatment sessions, and general schedule of treatment and follow-up were assessed. This was a retrospective study of 31 patients with CRS who were managed with trans-implant lavage. Of these patients, 28 (referred for a sinus elevation procedure) underwent a simultaneous implantation procedure and treatment of the sinusitis. Three patients received treatment for sinusitis via an already existing implant. The suggested sinusitis treatment protocol includes the drainage of pus through the punctured sinus floor and three sessions of antral irrigation/lavage, four cone beam computed tomography scans, and four transnasal endoscopic observations. The suggested combined protocol includes the simultaneous evaluation of the implant status and the sinusitis treatment results on days 30 and 60 after surgery. Of the 31 patients, 28 (90%) had complete relief of most of their symptoms (nasal obstruction/discharge, anosmia/hyposmia) up to day 30 postoperative. Follow-up nasal endoscopy demonstrated no evidence of active sinus disease. Twenty-seven implants were well-osseointegrated and were still in use for prosthetic purposes. In one case, the implantation failed because of poor bone quality. For the remaining 30 cases, both clinical and radiological results showed stability of the implants and no CRS recurrence during the whole follow-up period. The dental implant with an internal central port and an integral sealing screw may be used for drainage, irrigation, observation, and further treatment of the maxillary sinus in cases of CRS. [ABSTRACT FROM AUTHOR]

Penetrating traumatic injuries or laceration wounds in horses often affect joints and tendon sheaths. The open wound allows bacteria and foreign material to enter the joint or tendon sheath. A thorough lavage of the affected synovial space is required to remove bacteria, foreign material and inflammatory mediators. In cases with traumatic injuries, lavage is performed along with the surgical reconstruction of the injured tissue. In literature two methods for joint/tendon sheath lavage are generally acknowledged: the arthroscopic/tenoscopic guided lavage and a through-and-through needle lavage. The efficiency of both previously mentioned methods is discussed controversially, as arthroscopic/tenoscopic lavage provides higher flow rates and volumes of sterile irrigation fluid. Further, the synovial space can be visualized and debris can be removed under visual control. The advantages of the through-and-through needle lavage are the reduced costs and expense and the facilitated performance by less-experienced surgeons. In a case series of 60 foals treated with septic arthritis, both methods did not show any significant difference in outcome (Wright et al. 2017). This is consistent to a study describing an age-mixed population suffering septic arthritis from different etiologies (Schneider et al. 1992). However, other authors favor arthroscopic lavage to treat septic joints (ter Braake 2002). In cases of septic tenosynovitis, the surgical technique for lavage was not found to be associated with outcome (Wereska et al. 2007). A recent study from Duggan and Mair (2019) focusing on the outcome of horses suffering septic calcanean bursitis also concluded no dependence of lavage method and outcome. There is lack of information about the outcome of horses presented with septic arthritis due to a penetrating or lacerating wound treated with either arthroscopic or needle-lavage. Therefore, the aim of our study is to proof the efficiency of a through-and-through needle lavage in horses with penetrating traumatic joint and tendon sheath injuries. We hypothesized no significant difference regarding complications and outcome in comparison to horses treated with arthroscopic/ tenoscopic guided lavage. We assumed other factors to be associated with outcome. Data from clinical records from the Department for Horses at the University of Leipzig from the years November 2008 to August 2019 were analyzed. Horses were included if they were presented with a joint or tendon sheath penetrating injury treated surgically with either arthroscopic/tenoscopic lavage or needle lavage and primary wound closure. Horses with accompanying bone injuries were excluded from the study. The age of the horse, localization of the synovial injury, duration of injury, results of synovial analysis, antimicrobial therapy and hospitalization time were documented. Outcome was defined in terms of being discharged from the clinic without lameness when walked. Results were evaluated descriptively and tested for normal distribution using the Shapiro-Wilk test. Groups were compared using the Mann-Whitney-test. Data were further analyzed with Fisher's exact test to test statistical correlation. Significance was set at p < 0.05. Within that time 42 horses met the inclusion criteria, 31 were lavaged arthroscopically/tenoscopically, 10 via needle lavage and one horse with two injured synovial structures was treated with both methods. There was no significant difference for horses to be discharged non-lame when walked among those groups. Also, the necessity to repeat lavage treatments did not depend on the initial lavage method. The age of the wound (≤6 hours versus > 6 hours) as well as synovial parameters like white cell count, percentage of polymorphonuclear leucocytes, total protein and proof of bacteria did not influence the outcome. Horses with shorter systemic antibiotic therapy and shorter hospitalization time were significant more likely to be discharged non-lame at walk. This study suggests that in cases with penetrating or lacerating joint and tendon sheath injuries the method for joint/tendon sheath lavage is not associated with the outcome. Through-and-through needle lavage is a considered equivalent to arthroscopic/tenoscopic joint/tendon sheath lavage in such cases. [ABSTRACT FROM AUTHOR]

Diverticulitis is a common disease in western countries, and its incidence is likely expected to increase over years. The burden of diverticular disease on health systems and resources utilization cannot be underestimated, given the high prevalence of diverticulosis and the rate of patients requiring hospitalization and/or surgery. Minimally invasive colorectal surgery can guarantee several benefits over traditional open surgery, even more prominently in the emergency settings. However, there is moderate to low agreement regarding the use of a minimally invasive approach in patients with perforated diverticular disease (Hinchey III/IV), as well as primary anastomosis is still feared too risky versus end colostomy. Over the last years, evidence has been growing that laparoscopy can reduce the magnitude of surgical injury, and last but not least, cause less adhesions and/or incisional hernias, and lead to easier subsequent surgeries. The recently published results from the DIVA arm of the Ladies trial showed that 12-month stoma-free survival was significantly better for patients randomized to primary anastomosis compared with patients who received Hartmann's procedure, without differences in short-term morbidity and mortality after index resection. Moreover, several recent studies showed that laparoscopic sigmoidectomy in the treatment of Hinchey III–IV diverticulitis is feasible in haemodynamically stable patients. Taken together, these findings suggest that laparoscopic sigmoidectomy is at least feasible and safe in this challenging subgroup of patients. However, patient selection and additional factors, including surgeon expertise and hospital resources, are crucial and need careful consideration. [ABSTRACT FROM AUTHOR]

The clinical significance of tumor-positive peritoneal cytology (CYT+) in gastric cancer (GC) patients is unclear. This nationwide cohort study aimed to i) assess the frequency of cytological analysis at staging laparoscopy; ii) determine the prevalence of CYT+GC; and iii) compare overall survival (OS) in CYT+ patients versus those with (PM+) and those without (PM-) macroscopic peritoneal disease. All patients diagnosed with cT1–4, cN0–2 and M0 or synchronous PM GC between 2016–2021 were identified in the Netherlands Cancer Registry database and linked to the nationwide pathology database. A total of 4397 patients was included, of which 40 % underwent cytological assessment following staging laparoscopy (863/1745). The prevalence of CYT+ was 8 %. A total of 69 patients had CYT+(1.6 %), 789 (17.9 %) had PM+ and 3539 (80.5 %) had PM- disease. Hazard ratio for OS in CYT+ versus PM+ was 0.86 (95 %CI 0.64–1.17, p-value=0.338), and in PM- versus PM+0.43 (95 %CI 0.38–0.49, p-value<0.001). No survival difference was found between systemic chemotherapy versus surgical resection in CYT+ patients. In this nationwide study, OS for gastric cancer patients with CYT+ was equally unfavorable as for those with PM+ and significantly worse as compared to those with PM-. The optimal treatment strategy has yet to be established. [Display omitted] • Tumor-positive peritoneal cytology and PM in GC had a comparable dismal survival. • Surgery and systemic treatment in CYT+ patients showed equal survival figures. • Staging laparoscopy including cytology improves patient selection for GC therapy. [ABSTRACT FROM AUTHOR]

Studies on canine respiratory diseases are scant in the literature especially in Africa, unlike the situation on ruminants. This study is on the pathology and bronchoalveolar cellular and oxidative stress changes in naturally occurring canine pneumonia in Nigeria. The dogs used were collected from cases submitted for necropsy in the institutional Department of Veterinary Pathology. Gross examination, bronchoalveolar lavage (BAL) cytology, oxidative biochemical assay of BAL fluid (BALf) supernatant and histology of sections from all the lung lobes were done using standard procedures. Grossly, 22 (31%) were normal while 48 (69%) were congested, haemorrhagic and/or pneumonic out of the 70 canine lungs examined. Microscopically, there were pulmonary congestion (4%), pulmonary oedema (20%), pulmonary haemorrhages (7%), atelectasis (4%), interstitial pneumonia (10%), bronchointerstitial pneumonia (14%) and bronchopneumonia (9%). The BALf cytology of pneumonic lungs showed increases in neutrophils, alveolar macrophages, lymphocytes and haemosiderophages including free and phagocytosed bacteria, and fungal hyphae. Glutathione peroxidase (GPx) and glutathione transferase (GST) activities increased in congested and bronchointerstitial pneumonic lungs but were reduced in other pneumonic lungs. The superoxide dismutase (SOD) activity was significantly reduced in the pneumonic canine lungs. Hydrogen peroxide generation increased in congestion and oedema, bronchopneumonia and bronchointerstitial pneumonia. Malondialdehyde (MDA) level increased in other congested and pneumonic lungs. There was also significant positive correlation of BALf pro-oxidant assay to the type and severity of pneumonia (+ 0.75, P < 0.05). Pneumonias account for 57.2% of the respiratory conditions of which bronchointerstitial and interstitial pneumonias are the prevalent types. The study also showed that oxidative stress markers in BALf may serve as predictors of pneumonia especially in the early stages. Since treatment recommendations for pneumonia often centre primarily on supportive care and anti-oxidant and antibiotic administration, further studies on causal agents, treatment and prevention strategies for canine pneumonia in Nigeria are warranted. [ABSTRACT FROM AUTHOR]

There is no study comparing large volume lavage through image guided percutaneously placed drains in severe acute pancreatitis. Of the 114 randomized patients, 60 eligible candidates were randomly allocated to – Lavage Treatment (LT) group (28 patients) and Dependent Drainage (DD) group (32 patients). Primary end point was reversal of pre-existing organ failure, development of new onset organ failure, need for surgery, mortality and hospital stay. Both the groups were comparable in terms of demographic data, onset and severity of pancreatitis. LT group had higher infected pancreatic necrosis (75% vs 50%,p = 0.047). On intention to treat analysis, lavage treatment group showed a significant reversal of persistent organ failure (84% vs 50%, p = 0.23), reduction in APACHEII scores (3.5 ± 3.405 vs 1.16 ± 3.811 p = 0.012), as measured at the time of placement of PCD to cessation of intervention. There was no difference in development of new onset organ failure in the two groups (25% vs37.5% p=.290). 75% in LT group and 69% in DD group improved with PCD alone. There was no difference in the catheter related complications and number of catheters used. The need for surgical intervention was comparable in two groups (18.8% vs 14.3% p=.737). There was a trend toward decreased mortality in group A (18.8% vs 28.8% p=.370). Large volume lavage trough PCD improves organ failure and this translates into trend towards reduced mortality. [ABSTRACT FROM AUTHOR]

Background: Acute diverticulitis (AD) presents a unique diagnostic and therapeutic challenge for general surgeons. This collaborative project between EAES and SAGES aimed to summarize recent evidence and draw statements of recommendation to guide our members on comprehensive AD management.Methods: Systematic reviews of the literature were conducted across six AD topics by an international steering group including experts from both societies. Topics encompassed the epidemiology, diagnosis, management of non-complicated and complicated AD as well as emergency and elective operative AD management. Consensus statements and recommendations were generated, and the quality of the evidence and recommendation strength rated with the GRADE system. Modified Delphi methodology was used to reach consensus among experts prior to surveying the EAES and SAGES membership on the recommendations and likelihood to impact their practice. Results were presented at both EAES and SAGES annual meetings with live re-voting carried out for recommendations with < 70% agreement.Results: A total of 51 consensus statements and 41 recommendations across all six topics were agreed upon by the experts and submitted for members' online voting. Based on 1004 complete surveys and over 300 live votes at the SAGES and EAES Diverticulitis Consensus Conference (DCC), consensus was achieved for 97.6% (40/41) of recommendations with 92% (38/41) agreement on the likelihood that these recommendations would change practice if not already applied. Areas of persistent disagreement included the selective use of imaging to guide AD diagnosis, recommendations against antibiotics in non-complicated AD, and routine colonic evaluation after resolution of non-complicated diverticulitis.Conclusion: This joint EAES and SAGES consensus conference updates clinicians on the current evidence and provides a set of recommendations that can guide clinical AD management practice. [ABSTRACT FROM AUTHOR]

The aim of this work was to analyze the results of a percutaneous drainage technique with 2 catheters during surgical treatment of phlegmons of the finger flexor tendon sheath. Our series included 32 patients with a phlegmon of flexor tendon sheaths, including 19 men and 13 women, mean age 43.4 years. The first 16 patients (group I) were treated by a conventional open technique for the lavage and drainage of the affected tendon sheath. The last 16 (group II) were treated by an ultrasound-guided percutaneous lavage technique with 2 catheters: one proximal and one distal. In the case of impermeability of the digital canal, conversion by open technique was carried out. In group II, the ultrasound-guided percutaneous lavage was 5 times successful. Failure of the proximal catheter alone was noted once, whereas failure of the distal catheter alone was noted 7 times. The failure of both catheters was noted 3 times. At a mean follow-up of 19.7 days, mean handgrip strength was 56.5% compared to the contralateral side in group I and 82% in group II (P < 0.05). However, there was no significant difference for pain, QuickDASH, total active mobility between group I and group II. Pain was at 1.4/10 for group I and 1.4/10 for group II. QuickDASH was measured at 27/100 for group I and 22.27/100 for group II. Total active mobility was 227° for group I and 243° for group II. In conclusion, surgical treatment of the phlegmons of the finger flexor tendon sheath with an ultrasound-guided percutaneous lavage technique gives significantly better short-term grip strength than the conventional open technique. [ABSTRACT FROM AUTHOR]

The Mulcahy salvage fundamentally altered the management of penile prosthesis infections (PPI). Central to this procedure is a sequence of antiseptic irrigations that aims to remove and eradicate pathogenic microflora from the infected field, thus preparing for immediate reimplantation. The antiseptic solutions and their respective concentrations, however, have never been evaluated for efficacy. This review critically examines 3 commonly used antiseptic irrigation solutions (povidone-iodine [PVI], hydrogen peroxide [H 2 O 2 ], and chlorhexidine gluconate [CHG]) in terms of their antimicrobial activity, cytotoxicity, and clinical use. A PubMed literature review was performed on articles published between 2003 and 2018. Both preclinical as well as clinical studies from various surgical disciplines were included in this review. The original salvage protocol selected for irrigation solutions at concentrations that are likely detrimental to native tissue. All 3 agents demonstrate in vitro cytotoxic effects at subclinical concentrations, but H 2 O 2 is associated with the most significant deleterious properties. It does not seem to broaden antimicrobial coverage beyond what is covered by PVI. Dilute PVI (0.35–3.5% with exposure time of at least 3 minutes) possesses the most robust clinical evidence as an intraoperative adjunct, reducing the incidence of postoperative infectious complications. chlorhexidine gluconate is a promising new agent but lacks clinical data. Improvements in the salvage protocol are warranted based on current evidence. Careful selection of lavage solution and usage of the lowest necessary concentration will help achieve desired antimicrobial activity while avoiding native tissue cytotoxicity. Strength and limitation: The study is limited by its retrospective nature, and the heterogeneity of literature reviewed precluded a formal meta-analysis. Furthermore, future studies will need to address the roles of normal saline and antibiotic irrigations as intraoperative adjuncts for infection prevention. Diluted PVI (0.35–3.5% for 3 minutes) may be beneficial in the prevention of PPI. Evidence supports its use both in the setting of primary implantation as well as salvage of infected hardware. An improved, evidence-based protocol may increase positive outcomes of urologic prosthetic surgery. Pan S, Rodriguez D, Thirumavalavan N, et al. The Use of Antiseptic Solutions in the Prevention and Management of Penile Prosthesis Infections: A Review of the Cytotoxic and Microbiological Effects of Common Irrigation Solutions. J Sex Med 2019;16:781–790. [ABSTRACT FROM AUTHOR]

Objective: Our objective is to propose a simple procedure for evaluating potential recent heavy exposure to tremolite. Methods: One day after an accidental exposure to tremolite in rock dust, sputum was sampled; 3 months later a laryngeal lavage was taken. The sputum was examined with scanning electron microscopy (SEM); the lavage was examined with transmission electron microscopy (TEM). Results: The sputum was found to contain abundant tremolite while the lavage contained very thin, high aspect-ratio fibers, many in the "Stanton Fiber" range. The abundance of tremolite from the larynx suggests accumulation. The thin fibers exhibit splitting from thicker fibers that were in the lungs. Conclusions: Laryngeal lavage may be an important index of asbestos exposure and is a less complex and more diagnostic alternative to bronchoalveolar lavage or sputum sampling. [ABSTRACT FROM AUTHOR]

Introduction: Vertebral involvement is found in a high percentage of multiple myeloma (MM) patients, often requiring multilevel surgical treatment to reduce pain and disability and to receive prompt access to oncological care. We describe the clinical use of washout technique for multilevel vertebroplasty in MM patients with diffuse spinal involvement. The aim of this technique is to reduce the risk of pulmonary fat embolism after cement injection and possibly to increment the amount of cement and treated levels in one surgical stage.Methods: Three patients were treated with the washout technique prior to multilevel vertebroplasty for thoracolumbar diffuse spinal involvement in multiple myeloma. We describe the surgical technique and review the pertinent literature.Results: The technique is clinically safe and effective in reducing pain, without significant complications. Two six-level vertebroplasties were performed in one case, allowing a larger amount of cement injected and a prompt start of the oncological treatment.Conclusions: Multilevel vertebroplasty in MM patients with diffuse spinal involvement carries the advantages of reducing pain, avoid repeated surgeries and faster return to oncological regimen. Cardiovascular complications, including pulmonary embolism, are rare but can have fatal consequences. It is mainly due to bone marrow mobilization during cement injection and the risk increases with the amount of cement injected and the number of treated levels. Despite multilevel treatment at the same stage, we did not observe any significant complication in our series. Further studies are needed to confirm the preliminary results of this technique. These slides can be retrieved under electronic supplementary material. [ABSTRACT FROM AUTHOR]

ABSTRACT: This article will look at the short-term surgical management of a cat with a cat bite abscess (CBA), requiring surgical debridement of the wound and drain placement. Planning is an important skill in surgical nursing which can reduce anaesthetic duration and lead to improved surgical outcome. Extensive preparation was required in this case, including solutions for skin scrub and lavage along with equipment for surgery and anaesthesia. Lavage is explored including the use of isotonic solutions, pressures and technique. Hartmann's is recommended for wound lavage with the use of a 20 ml syringe and an 18-19-gauge needle. Chlorhexidine solutions should be used with caution. Post-operatively patients with drains should have sterile absorbent dressings and Elizabethan collars to prevent ascending infection and premature drain removal. However, neither were possible in this case due to the position of the wound and management with T-shirts were necessary. [ABSTRACT FROM AUTHOR]

Bacterial ventriculitis is one of the most common and serious complications of shunt placement. Shunt infection has varied management and is difficult to treat neurosurgically. We report a case of intraventricular empyema due to shunt infection. Standard management was failed for this case and reaccumulation of pus in the both ventricles. Neuroendoscopic surgery with intraventricular lavage and aspiration using cannula nasogastric tube (NGT) through a single burr hole, has successfully decreased the accumulation of intraventricular empyema. After lavage and aspiration, antibiotic can be distributed effectively to the affected area. Follow up imaging and cerebrospinal fluid (CSF) culture shown a good result and shorter length of stay in the hospital. Neuroendoscopy appears effective and safe for the management of bacterial ventriculitis due to shunt infection in infant. The strategy described in this report might be useful to treat intraventricular empyema.

Introduction: Growing concern for Tuberculosis (TB) epidemic forces World Health Organization (WHO) and government of India (GOI) to incorporate newer rapid and highly specific diagnostic test like Cartridge Based Nucleic Acid Amplification Test (CBNAAT). Aim: To find the usefulness of CBNAAT in increasing Acid Fast Bacilli (AFB) positive patient pool over and above the yield of traditional sputum microscopy. Materials and Methods: The cross-sectional survey was conducted in the Department of Respiratory Medicine, Nilratan Sircar Medical College and Hospital (NRSMCH), Kolkata, India. The study involved 94 smear negative TB suspects referred from other health facilities as well as diagnosed by the department itself. After collecting baseline information like age, sex, previous history of TB and its treatment by interview and scrutinizing records using predesigned questionnaire, the patients were put on sputum CBNAAT and Broncho-Alveolar Lavage (BAL)- CBNAAT testing. Data were analysed by estimating mean, Standard Deviation (SD), proportion and using independent t-test, chi-square test. Results: Overall, average age of participants was 44.7±15.3 (mean±SD) years. Male-female ratio was 1:2.8. Altogether 44.7% patients were detected sputum positive out of which 34.0% were detected only by sputum CBNAAT and another 10.7% detected when BAL-CBNAAT testing was used among the negatives yielded from sputum CBNAAT only. These differences were statistically significant. Conclusion: Utility of CBNAAT over and above traditional diagnostic methods was reaffirmed. With added advantage of detecting MDR cases simple, sensitive, speedy and automated CBNAAT seems new mile stone in ‘Stop TB’ strategy and needs utilised to its highest potentiality through monitoring and supervision.

Introduction: Probiotics have been investigated for their many health benefits and impact on the microbiota of the gut. Recent data have also supported a gut-lung axis regarding the bacterial populations (microbiomes) of the two locations; however, little research has been performed to determine the effects of oral probiotics on the microbiome of the bovine respiratory tract. We hypothesized that probiotic treatment would result in changes in the lung microbiome as measured in lung lavage fluid. Our overall goal was to characterize bacterial populations in the lungs of calves fed probiotics in milk replacer and dry rations from birth to weaning., Methods: A group of 20 dairy calves was split into two treatment groups: probiotic (TRT; N  = 10, milk replacer +5 g/d probiotics; Bovamine Dairy, Chr. Hansen, Inc., Milwaukee, WI) and control (CON; N  = 10, milk replacer only). On day 0, birth weight was obtained, and calves were provided colostrum as per the dairy SOP. On day 2, probiotics were added to the milk replacer of the treated group and then included in their dry ration. Lung lavages were performed on day 52 on five random calves selected from each treatment group. DNA was extracted from lavage fluid, and 16S ribosomal RNA (rRNA) gene hypervariable regions 1-3 were amplified by PCR and sequenced using next-generation sequencing (Illumina MiSeq) for the identification of the bacterial taxa present. Taxa were classified into both operational taxonomic units (OTUs) and amplicon sequence variants (ASVs)., Results: Overall, the evaluation of these samples revealed that the bacterial genera identified in the lung lavage samples of probiotic-fed calves as compared to the control calves were significantly different based on the OTU dataset ( p  < 0.05) and approached significance for the ASV dataset ( p  < 0.06). Additionally, when comparing the diversity of taxa in lung lavage samples to nasal and tonsil samples, taxa diversity of lung samples was significantly lower ( p  < 0.05)., Discussion: In conclusion, analysis of the respiratory microbiome in lung lavage samples after probiotic treatment provides insight into the distribution of bacterial populations in response to oral probiotics and demonstrates that oral probiotics affect more than the gut microbiome., Competing Interests: TM, SE, AD, and CC-M were employed by the USDA. KB was employed by the Chr. Hansen, Inc. Mention of trade names or commercial products in this publication is solely for the purpose of providing specific information and does not imply recommendation or endorsement by the U.S. Department of Agriculture. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 McDaneld, Eicher, Dickey, Kritchevsky, Bryan and Chitko-McKown.)

Objectives: To evaluate in patients with untreated adult periodontitis, the effect of treatment with a novel pocket irrigator/evacuator device (IED) compared to conventional subgingival debridement (CPT), both provided during the initial phase of active periodontal therapy. Methods: This study was an examiner‐blind, randomized controlled clinical trial using a split‐mouth design. Systemically healthy patients with adult periodontitis were selected. Full‐mouth probing pocket depth (PPD), gingival bleeding on pocket probing scores (BOPP), gingival recession (REC) and dental plaque (PI) were assessed at baseline. All participants received oral hygiene instructions and supragingival prophylaxis including polishing. In 2 randomly assigned contra‐lateral quadrants, approximal sites were irrigated with the IED, whereas in the other quadrants, CPT was provided. The CPT consisted of subgingival debridement using ultrasonic devices followed by the use of hand instruments. At 3 months post‐treatment, the clinical parameters were re‐assessed. Results: Twenty‐five patients met the inclusion criteria and were willing to participate. At 3 months post‐treatment, the PPD and BOPP had significantly improved for both treatment modalities. Pockets of ≥5 mm reduced by 0.64 mm in the IED group (P < .001), compared to a reduction of 0.82 mm for the CPT group (P < .001). With respect to the primary outcome parameter (PPD) and BI, the results with the IED were less pronounced. Between the test and control groups, no significant differences were observed for REC and PI. Conclusions: Oral hygiene instructions, supragingival prophylaxis and subgingival lavage with the IED resulted in a significant reduction in PPD and BOPP. However, the effect does not reach the results of CPT which included the subgingival use of ultrasonic and hand instruments. [ABSTRACT FROM AUTHOR]

To evaluate factors associated with failure in patients treated with DAIR (debridement, antibiotic therapy, and implant retention) for Staphylococcus aureus prosthetic joint infections (PJIs). We retrospectively analyzed consecutive patients with stable PJI due to S. aureus treated with DAIR at six hospitals between 2010 and 2014. Cox proportional hazards regression was used to study factors associated with treatment failure at 2 years. Of 154 eligible patients, 137 were included (mean age 73 ± 13 years; male 56%). The estimated success rate according to the Kaplan-Meier method was 76.2 [95% CI 68-83] at 2 years of follow-up. In multivariate analysis, longer duration of treatment (hazard ratio (HR) 0.78 [0.69-0.88]; p < 0.001) and combination therapy including rifampin (HR 0.08 [0.018-0.36]; p = 0.001) were independently associated with success, whereas active smoking was independently associated with failure (HR 3.6 [1.09-11.84]; p = 0.036). When the analysis was restricted to patients with early infection onset (< 3 months), early acute infection was also predictive of a better prognosis (HR 0.25 [0.09-0.7]; p = 0.009). Failure was not associated with time from prosthesis insertion to debridement, nor with duration of symptoms > 3 weeks and type of prosthesis (hip or knee). These results remained unchanged when the 14 patients under immunosuppressive therapy were removed from analysis. These data suggest that DAIR can be performed even if infection and symptoms are delayed but reserved to patients who are able to follow rifampin-based combination therapy for a prolonged duration that should not be different for hip and knee PJI. [ABSTRACT FROM AUTHOR]

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Uterine luminal pH has been demonstrated to be a valid indicator of uterine health in species such as cattle and sheep. However, research regarding uterine luminal pH in equines is lacking. The objectives of this study were to assess uterine luminal pH in mares during the estrous cycle, and evaluate the effect of dilute vinegar lavage on both uterine luminal pH and endometrial health. The study was conducted using a randomized block design in which eight mares (four Thoroughbred and four Standardbred) were aged matched then randomly assigned to two groups. Endometrial biopsies were taken from each mare prior to trial commencement. The treatment group (n = 4; 1 Thoroughbred, 3 Standardbreds) received a uterine lavage of one liter dilute vinegar (20 mL of vinegar in 1 L saline) every second day during each estrus period throughout the trial. Control group mares did not receive a uterine lavage. Uterine luminal pH measurements were recorded in all mares in both groups for a period of up to 10 min immediately prior to lavage (0 h), one hour and 24 h post lavage (same time points in control group mares as if they had been treated). Diestrus uterine luminal pH measurements were recorded once between days 6–10 post-ovulation. Endometrial biopsies were repeated from all mares at trial completion. Mean uterine luminal pH ranged from pH 5.3 to 7.6 and was significantly lower during diestrus compared to estrus (P < 0.001). Regression analysis indicated that this variation in pH was best explained by estrous cycle day, with uterine luminal pH increasing by a mean of 0.03 units each day (P < 0.001) from 6 to 10 days post-ovulation through to ovulation. Uterine lavage with dilute vinegar did not significantly affect uterine luminal pH (P > 0.05). A scoring system to quantify the abundance of cell types in the endometrial biopsies showed that mares in the treatment group had a significant decrease in polymorphonuclear cell abundance between pre- and post-trial biopsies (P = 0.03). Mares in the treatment group also had a significant decrease in lymphocyte, plasma cell and eosinophil cell abundance (P = 0.05). Although dilute vinegar lavage was not associated with a significant change in uterine luminal pH, it was associated with a significant improvement in endometrial biopsy scores. Because the control group did not receive a uterine lavage, further research is required to determine if this significant improvement results from the addition of dilute vinegar, or the uterine lavage itself. [ABSTRACT FROM AUTHOR]

Bacterial ventriculitis is one of the most common and serious complications of shunt placement. Shunt infection has varied management and is difficult to treat neurosurgically. We report a case of intraventricular empyema due to shunt infection. Standard management was failed for this case and reaccumulation of pus in the both ventricles. Neuroendoscopic surgery with intraventricular lavage and aspiration using cannula nasogastric tube (NGT) through a single burr hole, has successfully decreased the accumulation of intraventricular empyema. After lavage and aspiration, antibiotic can be distributed effectively to the affected area. Follow up imaging and cerebrospinal fluid (CSF) culture shown a good result and shorter length of stay in the hospital. Neuroendoscopy appears effective and safe for the management of bacterial ventriculitis due to shunt infection in infant. The strategy described in this report might be useful to treat intraventricular empyema. [ABSTRACT FROM AUTHOR]

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