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Background: This study aimed to evaluate the risk and timing of postoperative bleeding complications following breast-conserving surgery (BCS), with or without axillary surgery, especially in relation to perioperative management of antithrombotic medications. Methods: Data from all patients who underwent BCS for breast cancer between 2010 and 2022 at a single university hospital were collected. Medical records were reviewed for reoperations, unplanned admissions, and patient characteristics. Results: In total, 4712 breast-conserving surgeries and 3631 axillary surgeries were performed on 3838 patients. The risk of any bleeding complication was 1.1% (40/3571) in breast-conserving surgery, 0.3% (9/2847) in sentinel lymph node biopsy, and 0.5% (4/779) in axillary lymph node dissection. Upon arrival for treatment, 645 (17%) patients were taking antithrombotic medications. The risk of bleeding complications was not elevated in patients whose medication was discontinued at least a day before the surgery (OR 0.84, p = 0.76); but it was almost four-fold (OR 3.61, p = 0.026) in patients whose antithrombotic medication was continued. However, the absolute risk for bleeding complication was low in these patients as well (2.0%, 15/751). The majority of bleeding complications (85%, 47/55) occurred within 24 h after the surgery. Conclusion: The risk for bleeding complications was elevated, but still low, after BCS with or without axillary surgery, when antithrombotic medications were continued through the surgical period. Discontinuing antithrombotic medications is not obligatory in these patients. [ABSTRACT FROM AUTHOR]

Haematomas of the lower limb are traumatic wounds that can have serious and often debilitating consequences; especially in the aged. Wound healing may be protracted due to multiple factors including disruptive consumer behaviours from poor cognition from dementia. This case study describes the management of an elderly consumer with dementia in a nursing home who sustained an extensive haematoma that resulted in a complex wound. Wound management was provided under local restrictions imposed by COVID-19. The importance of using holistic wound assessment frameworks and evidence-based approaches to wound management to achieve positive wound healing outcomes are emphasised. [ABSTRACT FROM AUTHOR]

Abstract Background This study aimed to evaluate the risk and timing of postoperative bleeding complications following breast-conserving surgery (BCS), with or without axillary surgery, especially in relation to perioperative management of antithrombotic medications. Methods Data from all patients who underwent BCS for breast cancer between 2010 and 2022 at a single university hospital were collected. Medical records were reviewed for reoperations, unplanned admissions, and patient characteristics. Results In total, 4712 breast-conserving surgeries and 3631 axillary surgeries were performed on 3838 patients. The risk of any bleeding complication was 1.1% (40/3571) in breast-conserving surgery, 0.3% (9/2847) in sentinel lymph node biopsy, and 0.5% (4/779) in axillary lymph node dissection. Upon arrival for treatment, 645 (17%) patients were taking antithrombotic medications. The risk of bleeding complications was not elevated in patients whose medication was discontinued at least a day before the surgery (OR 0.84, p = 0.76); but it was almost four-fold (OR 3.61, p = 0.026) in patients whose antithrombotic medication was continued. However, the absolute risk for bleeding complication was low in these patients as well (2.0%, 15/751). The majority of bleeding complications (85%, 47/55) occurred within 24 h after the surgery. Conclusion The risk for bleeding complications was elevated, but still low, after BCS with or without axillary surgery, when antithrombotic medications were continued through the surgical period. Discontinuing antithrombotic medications is not obligatory in these patients.

Abstract Background This study was conducted to evaluate the differences between pre- and postoperative access conditions in percutaneous endovascular aortic repair (PEVAR). Methods Between December 2021 and October 2023, PEVAR was performed on 61 patients using the Perclose ProStyle (Abbott Vascular). Enhanced computed tomography and ankle-brachial index tests were performed preoperatively and postoperatively. The inner diameter and area of the iliofemoral artery were automatically measured, and the pre- and postoperative values were compared (114 legs). The same analysis was performed on 12 legs with previous groin operations; open surgical EVAR was performed in 9 legs, an endarterectomy of the femoral artery in 1, and a femoropopliteal bypass in the other leg. Results All patients were discharged without surgical site infections, lymphatic fistulas, or retroperitoneal haematomas. There were no significant differences between the pre-and postoperative inner diameter and inner area of the external iliac artery and common femoral artery. There were no significant differences between the preoperative and postoperative ankle-brachial index tests. In 12 legs with a previous groin operation, the postoperative ankle-brachial index tests and inner diameter and area of the external iliac artery and common femoral artery were statistically equal to the preoperative values. Conclusions This study can support the safety of percutaneous endovascular aortic repair, even in patients with redo groin operations.

Purpose: Mebos, a traditional South Africa confection consisting of dried, pulped, and sugared apricots, is rich in fibre and vitamins, but also contains salicylic acid, flavonoids, and citric acid. We report a case of postoperative surgical site bleeding in a healthy patient who consumed approximately 2 kg of mebos per day prior to his elective spinal surgery. Methods: The clinical course of a previously healthy 54-year-old male patient with cauda equina syndrome secondary to lumbar spinal stenosis who underwent surgical intervention with subsequent bleeding into the surgical site is discussed. The cause was investigated through biochemical analysis, thromboelastometry (ROTEM®) and mass and absorption spectrometry were applied to assess flavonoid, citric acid, and salicylic acid content. Results: ROTEM® revealed an abnormal clotting profile with an increased clot forming time, suggesting intrinsic coagulopathy. Mass and absorption spectrometry revealed a high total flavonoid content as well as citric acid concentration in the mebos. Salicylic acid was at detection limits of the instrument. Conclusion: Results highlighted the effect of flavonoids and citric acid and therefore explain the abnormal clotting profile in this patient. Inhibition of coagulation prior to elective surgery is a known contraindication and may pose great risks in spinal surgery. In the present report, we demonstrated an association between inhibition of coagulation and an excess of the flavonoids content and citric acid concentration in mebos consumed in the days prior to elective spinal surgery. [ABSTRACT FROM AUTHOR]

• In our cohort, persistent posterior MMA division filling after middle meningeal artery embolisation was significantly associated with collection recurrence. • Our results suggest MMAe as a stand-alone or adjuvant therapy can be performed safely in a UK neuroscience setting. • Our results suggest MMAe is associated with high rates of symptomatic CSDH size reduction or resolution in problematic CSDH that have either recurred or are prone to recurrence. Recurrence rates following surgical management of chronic subdural haematoma (CSDH) range from 5 to 33 %. There is growing evidence which suggests middle meningeal artery embolisation (MMAe) may reduce recurrence rates when used as surgical adjunct or standalone treatment. In this study we described our experience of this new procedure in the our UK institution. Patients with recurrent CSDH or CSDH at high risk of recurrence were selected for MMAe on a case-by-case basis following MDT discussion. A departmental database was used to identify patients treated. 26 CSDH were embolised in 20 patients; 9 CSDH were de-novo and 17 were recurrent. 10/26 CSDH were treated with MMAe only. No procedural mortality, access site or thrombo-embolic complications occurred. One patient experienced symptomatic collection growth 12 h following MMAe and required surgical drainage. 15 (75 %) of patients were living at home at follow-up (mean 14 months). On imaging follow-up 15/18 showed CSDH volume reduction or resolution, 1/18 remained stable requiring no further treatment, 2/18 patients suffered recurrent CSDH requiring treatment. In both recurrent cases incomplete embolisation was noted on procedural imaging (posterior division of MMA not embolised). Persistent posterior MMA division filling was significantly associated with collection recurrence (p = 0.002). Our results suggest MMAe as a stand-alone or adjuvant therapy can be performed safely in a UK neuroscience setting and is associated with high rates of symptomatic CSDH size reduction or resolution in problematic CSDH that have either recurred or are prone to recurrence. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to determine the fracture haematoma (fxH) proteome after multiple trauma using label-free proteomics, comparing two different fracture treatment strategies. Methods: A porcine multiple trauma model was used in which two fracture treatment strategies were compared: early total care (ETC) and damage control orthopaedics (DCO). fxH was harvested and analyzed using liquid chromatography-tandem mass spectrometry. Per group, discriminating proteins were identified and protein interaction analyses were performed to further elucidate key biomolecular pathways in the early fracture healing phase. Results: The early fxH proteome was characterized by immunomodulatory and osteogenic proteins, and proteins involved in the coagulation cascade. Treatment-specific proteome alterations were observed. The fxH proteome of the ETC group showed increased expression of pro-inflammatory proteins related to, among others, activation of the complement system, neutrophil functioning, and macrophage activation, while showing decreased expression of proteins related to osteogenesis and tissue remodelling. Conversely, the fxH proteome of the DCO group contained various upregulated or exclusively detected proteins related to tissue regeneration and remodelling, and proteins related to anti-inflammatory and osteogenic processes. Conclusion: The early fxH proteome of the ETC group was characterized by the expression of immunomodulatory, mainly pro-inflammatory, proteins, whereas the early fxH proteome of the DCO group was more regenerative and osteogenic in nature. These findings match clinical observations, in which enhanced surgical trauma after multiple trauma causes dysbalanced inflammation, potentially leading to reduced tissue regeneration, and gained insights into regulatory mechanisms of fracture healing after severe trauma. Cite this article: Bone Joint Res 2024;13(5):214–225.

Background and Objectives: The majority of complications arise within a month following modified radical mastectomy in breast cancer patients. In order to mitigate and lessen postoperative complications, this study aimed to determine the frequency of early postoperative complications of modified Radical Mastectomy within a four-week timeframe. Methods: A cross-sectional case series using a non-probability convenient sampling technique was conducted at a Tertiary care hospital for 14 months. A total of 112 patients diagnosed with breast cancer via FNAC were included, while those who underwent neoadjuvant chemotherapy or radiotherapy, had inflammatory breast cancer, metastasis, or co-morbidities were excluded. Patients were operated on by a senior consultant. Daily followup was conducted until the 7th post-operative day, followed by weekly OPD visits for four weeks, and the final outcome was recorded. Results: A total of 39 patients experienced complications during the study, accounting for 34.82% of the total patients. The most frequent complication was breast seroma, with an elevated risk observed in patients aged over 50 years, tumor size exceeding 8 cm, weight exceeding 70 kg, and those with three or more palpable lymph nodes. Other complications included hematoma, lymphedema, wound infection, and shoulder dysfunction, while no instances of scar hypertrophy were observed. Conclusions: Seroma formation and hematoma were identified as the most common early complications following modified radical mastectomy. Lymphedema, wound infection, and shoulder dysfunction were noted in a smaller number of patients. [ABSTRACT FROM AUTHOR]

Haematoma is an early complication of tissue expander placement and can lead to infection, capsule contracture and various complications, hindering successful reconstruction. However, no scientific models can accurately predict the risk of haematoma following tissue expansion. Therefore, this study aimed to develop and validate a prediction model for haematoma following tissue expander placement. The medical records of patients who underwent expander placement between 2001 and 2021 were obtained from the clinical database of the Department of Plastic Surgery at the Xijing Hospital. A total of 4579 consecutive patients with 7080 expanders and 179 expanded pocket haematomas were analysed. Multivariate logistic regression analysis identified adult age (P = 0.006), male sex (P < 0.001), scar reconstruction (P = 0.019), perioperative hypertension (P < 0.001), face and neck location (P = 0.002) and activated partial thromboplastin time above the normal range (P < 0.001) as risk factors for haematoma. Therefore, these were included in the prediction model, and a nomogram was constructed. The discrimination of the nomogram was robust (area under the curve: 0.78; 95% confidence interval: 0.72–0.83). Further, the prediction model had a strong fit (Hosmer–Lemeshow test, P = 0.066) and maintained similar discrimination after considering performance optimism (bootstrapped area under the curve: 0.79; 95% confidence interval: 0.73–0.84). This clinical prediction model was created using a generalisable dataset and can be utilised to obtain valid haematoma predictions after expander placement, assisting surgeons in implementing preventive measures or interventions to reduce the occurrence of haematoma. [ABSTRACT FROM AUTHOR]

Laparoscopic‐assisted vaginal radical hysterectomy (LARVH) and abdominal radical hysterectomy (ARH) have been widely applied to treat cervical carcinoma. But LARVH and ARH have not been fully investigated in treating cervical carcinoma after injury associated with injury. This research is intended to provide an up‐to‐date basis for comparing LARVH with ARH in early stage cervical carcinoma. Comparison between LARVH and ARH in cervical carcinoma was carried out through a combination of related research. Eligible articles from databases such as PubMed and Embase were screened using an established search strategy. This report covered the results of LARVH versus ARH in cervical carcinoma. The average difference and the 95% confidence interval (CI) were used for the combination of consecutive variables. The combination of categorical variables was performed with the odds ratio (OR) 95% confidence interval. Through the identification of 1137 publications, eight of them were chosen to be analysed. Among them, 363 were treated with LARVH and 326 were treated with ARH. Eight trials showed that LARVH was associated with a reduced risk of postoperative wound infection than ARH (OR, 0.23; 95% CI, 0.1–0.55, p = 0.0009). Five trials showed that there was no difference in the risk of postoperative bleeding after surgery (OR, 1.17; 95% CI, 0.42–3.29, p = 0.76). We also did not differ significantly in the duration of the surgery (OR, 1.79; 95% CI, −6.58 to 10.15, p = 0.68). So, the two surgical methods differ significantly only in the risk of postoperative wound infection. [ABSTRACT FROM AUTHOR]

Two surgically treated haematomyelia cases were documented. One dog and one cat were presented for acute progressive paraplegia following a fall from height incident. Neurological examinations suggested a L4–S3 myelopathy in both cases. Radiography and magnetic resonance imaging in both cases revealed no fracture or subluxation of the spine, but well‐defined intramedullary mass lesions in lower lumbar regions compatible with haemorrhage and haematoma formation. Exploratory surgeries were performed over the lesions. Dark‐red friable masses were removed via myelotomy. Histopathological examinations revealed organizing haematomas at the acute to subacute stage. Postoperatively, both cases improved and regained ambulation. The dog walked normally but remained urinary and faecal incontinent 9 months after the surgery. The cat was continent and ambulatory with a paraparetic gait 5 months after the surgery. In both cases, the outcomes and the patients' quality of life were considered satisfactory by the owners. [ABSTRACT FROM AUTHOR]

Safe and effective arteriovenous fistula (AVF) puncture is very important to reduce the wound complications of haemodialysis (HD). For AVF puncture in dialysis patients, there is a lack of clarity and consistency regarding the relative advantage of buttonhole (BH) over rope‐ladder (RL) cannulae in terms of wound complications. The study was published in several scientific databases including Cochrane Library, PubMed and Embase by October 2023. Data from all controlled trials looking at the effect of BH and RL on wound complications in haemodialysis patients were included. The articles were written in English, and they were about adult who had AVF while on dialysis. Studies with or without BH or RL treatment were excluded from the analysis. The data was analysed with RevMan5.3 software. Out of 215 trials, 9 were chosen for the final analysis. The study publication dates were between 2000 and 2023. Of these, 17 326 patients received AVF therapy. Among them, there were 3070 BH and 14 256 RL. In 9 studies, RL had a lower risk of postoperative wound infection compared to BH (OR, 3.38; 95% CI, 3.06, 3.73 p < 0.0001); In all 3 studies, there were no statistically significant differences in the risk of post operative bleeding in RL versus BH(OR, 0.76; 95% CI, 0.25, 2.33 p = 0.63). Our studies have demonstrated that RL trocars are superior to BH trocars in the prevention of wound infection. [ABSTRACT FROM AUTHOR]

In the meta‐analysis, we evaluated the efficacy of placing drainage channels following single‐ or double‐level spine surgery in order to decrease the incidence of postoperative injury. We conducted the analysis with the help of four databases: PubMed, Embase, Cochrane Library and Web of Science. A review of related studies was carried out after evaluating the quality of the literature against the classification and exclusion criteria set for the trial. Calculation of 95% CI, OR and MD was performed with fixed‐effect models. A meta‐analysis of the data was carried out with RevMan 5.3. Meta‐analyses of randomized controlled trial (RCT) did not indicate that there were a statistically significantly different incidence of postoperative wound infections among those who received drainage compared to those who did not receive drainage (OR, 2.29; 95% CI, 0.50, 10.41 p = 0.28). Moreover, there were no statistically significant differences in post‐operation hematoma (OR, 1.20; 95% CI, 0.27, 5.28 p = 0.81) and visual analogue scale score (MD, −0.01; 95% CI, −1.34, 1.33 p = 0.99). Thus, placing drainage in short‐levels of spine operation did not significantly influence the outcome of postoperative wound complications. Nevertheless, because of the limited sample size chosen for this meta‐analysis, caution should be exercised when treating these data. More high‐quality RCT trials with a large number of samples are required to confirm the findings. [ABSTRACT FROM AUTHOR]

Abstract Background Mild traumatic brain injury (TBI) occupies majority of head traumas in most emergency units. Although patients with mild TBI can be reviewed and discharged on head injury advice, a sizeable number require admission for observation or intervention due to operable intracranial lesions. The aim of the study was to establish the prevalence of operable lesions in patients with mild TBI. Materials and methods This was a prospective study of consecutive adult patients with mild TBI who had cranial computerized tomography (CT) done at the National Trauma Centre, Abuja. All participants gave informed consent and the study had ethical clearance in the Hospital. Results One hundred and three mild TBI patients with cranial CTs were recruited aged 16–76 years with mean age of 32.25 $$\pm$$ ± 12.35 years. With intention to treat, twenty (20.4%) of them were diagnosed with operable intracranial lesions on CT scans, 19 males and 2 females. Majority of them (14; 66.7%) were young adults within 20–40 years of age. The lesions were 16 extradural haematomas (76.2%), 3 subdural haematomas (14.3%) and 2 depressed skull fractures (9.5%) of the operable cohort. Conclusions Significant number of patients with mild TBI had operable intracranial lesions. Therefore, there is need to screen patients with mild TBI appropriately in order to avoid missed operable lesions.

Introduction: Complications after major surgery are a significant cause of morbidity and mortality, and they have been shown to harm long-term quality of life. Lymph node status is the chief prognostic indicator. In the head and neck, complications from oncosurgeries can also delay adjuvant treatment, which is known to adversely affect survival. Neck dissection is a standard procedure for head and neck cancer following resections of the primary tumour. The invasive nature of neck dissection predisposes patients to a variety of intraoperative and postoperative complications. Aim: To analyse the complications in patients with head and neck malignancies following neck dissections. Materials and Methods: This was a single-centre cohort study conducted at the Department of Surgical Oncology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India. All patients diagnosed with head and neck malignancies who underwent neck dissections from July 2022 to December 2022 were included in the study. Complications such as bleeding, haematoma, infection, seroma, wound dehiscence, flap necrosis, fistula, chyle leak, shoulder dysfunction, and nerve and vascular injuries following various neck dissections were observed until discharge. The data was entered in Microsoft excel and results were expressed in terms of frequency and percentage. Results: A total of 67 patients were analysed in this study. Among them, 42 (62.7%) were males and 25 (37.3%) were females, with a mean age of 48 years and an age range of 25-84 years. Three patients underwent bilateral neck dissection, and a total of 70 neck sides were studied. Among the patients who received prior radiotherapy (20, 29.8%), 6 (30.0%) experienced complications, and there were no deaths. Conclusion: Head and neck surgery carries the potential for many complications due to the presence of major vessels and nerves. Carefully performed surgery is the cornerstone of success. Thorough preoperative assessment, proper surgical technique, and postoperative care are essential in preventing and managing complications. A step-by-step approach to studying details and conducting a complete check-up of the patient after the procedure ensures optimal results with minimal late side-effects and complications.

Background: Mild traumatic brain injury (TBI) occupies majority of head traumas in most emergency units. Although patients with mild TBI can be reviewed and discharged on head injury advice, a sizeable number require admission for observation or intervention due to operable intracranial lesions. The aim of the study was to establish the prevalence of operable lesions in patients with mild TBI. Materials and methods: This was a prospective study of consecutive adult patients with mild TBI who had cranial computerized tomography (CT) done at the National Trauma Centre, Abuja. All participants gave informed consent and the study had ethical clearance in the Hospital. Results: One hundred and three mild TBI patients with cranial CTs were recruited aged 16–76 years with mean age of 32.25 ± 12.35 years. With intention to treat, twenty (20.4%) of them were diagnosed with operable intracranial lesions on CT scans, 19 males and 2 females. Majority of them (14; 66.7%) were young adults within 20–40 years of age. The lesions were 16 extradural haematomas (76.2%), 3 subdural haematomas (14.3%) and 2 depressed skull fractures (9.5%) of the operable cohort. Conclusions: Significant number of patients with mild TBI had operable intracranial lesions. Therefore, there is need to screen patients with mild TBI appropriately in order to avoid missed operable lesions. [ABSTRACT FROM AUTHOR]

Introduction: Complications after major surgery are a significant cause of morbidity and mortality, and they have been shown to harm long-term quality of life. Lymph node status is the chief prognostic indicator. In the head and neck, complications from oncosurgeries can also delay adjuvant treatment, which is known to adversely affect survival. Neck dissection is a standard procedure for head and neck cancer following resections of the primary tumour. The invasive nature of neck dissection predisposes patients to a variety of intraoperative and postoperative complications. Aim: To analyse the complications in patients with head and neck malignancies following neck dissections. Materials and Methods: This was a single-centre cohort study conducted at the Department of Surgical Oncology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India. All patients diagnosed with head and neck malignancies who underwent neck dissections from July 2022 to December 2022 were included in the study. Complications such as bleeding, haematoma, infection, seroma, wound dehiscence, flap necrosis, fistula, chyle leak, shoulder dysfunction, and nerve and vascular injuries following various neck dissections were observed until discharge. The data was entered in Microsoft excel and results were expressed in terms of frequency and percentage. Results: A total of 67 patients were analysed in this study. Among them, 42 (62.7%) were males and 25 (37.3%) were females, with a mean age of 48 years and an age range of 25-84 years. Three patients underwent bilateral neck dissection, and a total of 70 neck sides were studied. Among the patients who received prior radiotherapy (20, 29.8%), 6 (30.0%) experienced complications, and there were no deaths. Conclusion: Head and neck surgery carries the potential for many complications due to the presence of major vessels and nerves. Carefully performed surgery is the cornerstone of success. Thorough preoperative assessment, proper surgical technique, and postoperative care are essential in preventing and managing complications. A step-by-step approach to studying details and conducting a complete check-up of the patient after the procedure ensures optimal results with minimal late side-effects and complications. [ABSTRACT FROM AUTHOR]

Intracerebral hemorrhage is a common neurological disease, and its pathological mechanism is complex. As the first recruited leukocyte subtype after intracerebral hemorrhage, neutrophils play an important role in tissue damage. In the past, it was considered that neutrophils performed their functions through phagocytosis, chemotaxis, and degranulation. In recent years, studies have found that neutrophils also have the function of secreting extracellular traps. Extracellular traps are fibrous structure composed of chromatin and granular proteins, which plays an important role in innate immunity. Studies have shown a large number of neutrophil extracellular traps in hematoma samples, plasma samples, and drainage samples after intracerebral hemorrhage. In this paper, we summarized the related mechanisms of neutrophil external traps and injury after intracerebral hemorrhage. Neutrophil extracellular traps are involved in the process of brain injury after intracerebral hemorrhage. The application of related inhibitors to inhibit the formation of neutrophil external traps or promote their dissolution can effectively alleviate the pathological damage caused by intracerebral hemorrhage. [ABSTRACT FROM AUTHOR]

This meta‐analysis examined the post‐operative wound effect of both obese and non‐obese in total hip arthroplasty (THA) patients. To gather as complete an overview as possible, the researchers took advantage of 4 databases—PubMed, Embase, Cochrane Library and Web of Science—to conduct a critical assessment. Following the development of inclusion and exclusion criteria, the researchers evaluated the quality of each document. A total of 9 related trials were conducted to determine the 95% CI (CI) and OR using a fixed‐effect model. The final meta‐analyses were conducted with RevMan 5.3. Our findings indicate that there is no statistically significant benefit in terms of post‐operative wound complications among obese and non‐obese patients. Obese subjects had a significantly higher risk of injury than those without obesity (OR, 1.43; 95% CI, 1.04, 1.95, p = 0.03); obesity was also associated with a significantly higher risk of operative site infection than in non‐obese subjects (OR, 1.96; 95% CI, 1.76, 2.18, p < 0.0001); and after surgery, there was also a significant increase in the risk of post‐operative wound infections among obese subjects than in non‐obese subjects (OR, 1.57; 95% CI, 1.34, 1.84, p < 0.0001). However, due to the small size of the cohort study in this meta‐study, caution is required in the analysis. More randomized, controlled studies will be needed to validate these results. [ABSTRACT FROM AUTHOR]

A meta‐analysis study was used to assess whether not placing a drain after thyroidectomy reduces postoperative wound complications. A critical review of the comprehensive literature up to May 2023 was conducted using four databases: PubMed, Embase, the Cochrane Library, and the web of science. Fourteen interrelated studies were reviewed after passing the inclusion and exclusion criteria established by the study and assessing the quality of the literature.95% confidence intervals (Cl) and odds ratios (OR) were calculated using fixed effects models. The data were meta‐analysed using RevMan 5.3 software. The results showed that the use of drains during thyroid surgery did not have a favourable impact on patients. Intraoperative placement of drains did not reduce postoperative wound haematoma formation in patients, (OR, 0.86; 95% CI, 0.54, 1.36 p = 0.52). However, the incidence of postoperative wound infection was significantly higher in patients with drains used in intraoperative thyroid surgery, (OR, 0.22; 95% CI, 0.10, 0.45 p < 0.0001). As the sample size of the randomised controlled study used for this meta‐analysis was limited, it is important to approach the findings with caution when interpreting the results.Conducting additional high‐quality research with larger sample sizes is crucial in order to further confirm these results and reduce the likelihood of duplication. [ABSTRACT FROM AUTHOR]

Abstract Two surgically treated haematomyelia cases were documented. One dog and one cat were presented for acute progressive paraplegia following a fall from height incident. Neurological examinations suggested a L4–S3 myelopathy in both cases. Radiography and magnetic resonance imaging in both cases revealed no fracture or subluxation of the spine, but well‐defined intramedullary mass lesions in lower lumbar regions compatible with haemorrhage and haematoma formation. Exploratory surgeries were performed over the lesions. Dark‐red friable masses were removed via myelotomy. Histopathological examinations revealed organizing haematomas at the acute to subacute stage. Postoperatively, both cases improved and regained ambulation. The dog walked normally but remained urinary and faecal incontinent 9 months after the surgery. The cat was continent and ambulatory with a paraparetic gait 5 months after the surgery. In both cases, the outcomes and the patients’ quality of life were considered satisfactory by the owners.

Repairing cartilage/subchondral bone defects that involve subchondral bone is a major challenge in clinical practice. Overall, the integrated repair of the structure and function of the osteochondral (OC) unit is very important. Some studies have demonstrated that the differentiation of cartilage is significantly enhanced by reducing the intake of nutrients such as lipids. This study demonstrates that using starvation can effectively optimize the therapeutic effect of bone marrow mesenchymal stem cells (BMSCs)-derived extracellular vesicles (EVs). A hyaluronic acid (HA)-based hydrogel containing starved BMSCs-EVs displayed continuous release for more than 3 weeks and significantly promoted the proliferation and biosynthesis of chondrocytes around the defect regulated by the forkhead-box class O (FOXO) pathway. When combined with vascular inhibitors, the hydrogel inhibited cartilage hypertrophy and facilitated the regeneration of hyaline cartilage. A porous methacrylate gelatine (GelMA)-based hydrogel containing calcium salt loaded with thrombin rapidly promoted haematoma formation upon contact with the bone marrow cavity to quickly block the pores and prevent the blood vessels in the bone marrow cavity from invading the cartilage layer. Furthermore, the haematoma could be used as nutrients to accelerate bone survival. The in vivo experiments demonstrated that the multifunctional lineage-specific hydrogel promoted the integrated regeneration of cartilage/subchondral bone. Thus, this hydrogel may represent a new strategy for osteochondral regeneration and repair.

Research assessing the outcome of brachiobasilic arteriovenous fistulas (BB‐AVF) after a one‐ and two‐stage technique was conducted. A strict review of the comprehensive literature up to May 2023 was carried out using four databases‐PubMed，Embase, Cochrane Library and web of science. Inclusion and exclusion criteria developed for the study were then applied to assess the quality of the literature, it was decided to review 12 interrelated studies.95% confidence intervals (Cl) and odds ratios (OR) were calculated using fixed effects models. The data were meta‐analysed using RevMan 5.3 software. The results showed that two‐stage technique with BB‐AVF reduced surgical site haematoma (SSH) formation, (OR, 2.28; 95% CI, 1.24–4.17, p = 0.008), and also reduced surgical site wound infection (SSWI) (OR, 1.86; 95% CI, 1.17–2.94, p = 0.008). There are, however, several small sample sizes in the selected studies for this meta‐analysis, so caution should be used when processing their values. There are more high‐quality studies with large sample sizes that should be considered for future meta‐analyses. [ABSTRACT FROM AUTHOR]

Shoulder fracture, infection, haematoma, debridement, revision surgery Keywords: shoulder fracture; infection; haematoma; debridement; revision surgery EN shoulder fracture infection haematoma debridement revision surgery 522 526 5 10/04/23 20231001 NES 231001 Introduction Glenohumeral fragility fractures are common in the elderly and occur as a result of low energy insults such as a fall from standing height.[1] Proximal humerus fractures are the 3 SP rd sp most common osteoporotic fracture treated in the outpatient setting[1] and carry a serious mortality risk of approximately 8%.[2] Therefore, these injuries require careful consideration of treatment options including surgical and non-surgical options, balancing the patient's functional baseline, co-morbidities and general frailty against risks of surgery and anaesthesia. [Extracted from the article]

Objective: The authors conducted this meta-analysis to identify risk factors for spinal epidural haematoma (SEH) among patients following spinal surgery. Methods: The authors systematically searched Pub: Med, Embase, and the Cochrane Library for articles that reported risk factors associated with the development of SEH in patients undergoing spinal surgery from inception to 2 July 2022. The pooled odds ratio (OR) was estimated using a random-effects model for each investigated factor. The evidence of observational studies was classified as high quality (Class I), moderate quality (Class II or III) and low quality (Class IV) based on sample size, Egger's P value and between-study heterogeneity. In addition, subgroup analyses stratified by study baseline characteristics and leave-one-out sensitivity analyses were performed to explore the potential sources of heterogeneity and the stability of the results. Results: Of 21 791 articles screened, 29 unique cohort studies comprising 150 252 patients were included in the data synthesis. Studies with high-quality evidence showed that older patients (≥60 years) (OR, 1.35; 95% CI, 1.03-1.77) were at higher risk for SEH. Studies with moderate-quality evidence suggested that patients with a BMI greater than or equal to 25 kg/m² (OR, 1.39; 95% CI, 1.10-1.76), hypertension (OR, 1.67; 95% CI, 1.28-2.17), and diabetes (OR, 1.25; 95% CI, 1.01-1.55) and those undergoing revision surgery (OR, 1.92; 95% CI, 1.15-3.25) and multilevel procedures (OR, 5.20; 95% CI, 2.89-9.37) were at higher risk for SEH. Meta-analysis revealed no association between tobacco use, operative time, anticoagulant use or American Society of Anesthesiologists (ASA) classification and SEH. Conclusions: Obvious risk factors for SEH include four patient-related risk factors, including older age, obesity, hypertension and diabetes, and two surgery-related risk factors, including revision surgery and multilevel procedures. These findings, however, must be interpreted with caution because most of these risk factors had small effect sizes. Nonetheless, they may help clinicians identify high-risk patients to improve prognosis. [ABSTRACT FROM AUTHOR]

Thromboembolic disease (TED) is an important health problem in Europe due to its high morbimortality. Pharmacological prevention is achieved with low-molecular-weight heparin (LMWH), among other strategies, which are supported by a high degree of evidence in the scientific literature. According to its safety data sheet, this injection produces local injuries at a rate of 0.1–1% after administration; however, these percentages are much lower than others reported in several studies focusing on LMWH (44–88%). This high incidence of injuries might be associated with procedural or individual variables. (1) Background: Among the most frequent side effects after the administration of LMWH are pain and haematomas (HMTs), which are influenced by obesity. We aimed to determine the relationship between abdominal skinfold (ASF) value and incidence of HMTs. In addition, I sought to determine how the risk of HMT changed with each mm increase in ASF. (2) Methods: A cross-sectional descriptive study developed in the hospital unit of orthopaedic and trauma surgery was conducted over one year. All participants in the sample were classified based on their ASF and the appearance and area of HMTs were assessed after the administration of enoxaparin. The STROBE checklist was used to evaluate the study. Descriptive statistical analysis and analysis of variance of non-parametric factors were carried out. (3) Results: In a sample of 202 participants (808 Clexane injections), more than 80% presented HMTs. More than 70% of the sample was overweight and more than 50% had an ASF > 36 millimetres (mm). (4) Conclusions: An ASF over 36 mm confers a higher risk of developing HMTs: with each mm increase in the ASF, the risk increases by 4%. Participants who are overweight or obese also present a higher risk of HMT, and these conditions correlate positively with the area of the HMTs. Providing education for the self-administration of the drug after discharge and information about the probability of suffering from local injuries in a more individualised way will lead to fewer primary care nursing consultations, more adherence to the antithrombotic treatment, and, as a consequence, a decrease in TED and health costs.

Spontaneous or fine-needle aspiration (FNA)-induced remission of primary hyperparathyroidism (PHPT) is an extremely rare phenomenon with variable outcomes. We report a 75-year-old Male who initially presented with left ureteric calculi and was found to have PHPT. Imaging studies including ultrasound neck, parathyroid sestamibi scan and computed tomography of thorax, abdomen, and pelvis failed to identify the culprit lesion and exploratory parathyroidectomy was planned. Before surgery, he underwent FNA for cytology of a right cold thyroid nodule which was complicated with a large neck haematoma and dysphagia. The cytology of the aspirated fluid was consistent with a benign cyst. One month after the procedure, serum calcium and phosphate normalised along with resolution of haematoma. He remained in biochemical remission at 1-year follow-up with the latest ultrasound of neck showing resolution of a large colloid nodule that was previously seen occupying the right thyroid lobe. [ABSTRACT FROM AUTHOR]

Tranexamic acid (TXA) reduces blood loss and blood transfusion requirements in surgery. Seroma and haematoma formation occur as complications of breast surgery. We aimed to perform a meta-analysis evaluating TXA in reducing post-operative haematoma and seroma formation for breast surgery. A systematic review was performed in accordance with PRISMA guidelines. Results were expressed as dichotomous variables pooled as odds ratios (OR) with corresponding 95% confidence intervals (CIs) using the Mantel–Haenszel method. Seven studies including 1446 patients were included. There were 1830 breast surgery procedures performed with TXA administered in 797 cases (43.6%). There was a significant reduction in haematoma rates in the TXA group (TXA: 3.184% (22/691) vs Control: 6.787% (64/943), OR: 0.41, 95% CI: 0.20–0.86, P = 0.020). Based on surgical procedure, haematoma rates were similar for TXA and control groups in cancer surgery (P = 0.230). Haematoma rates reduced following TXA use in cosmetic procedures (TXA: 3.807% (15/394) vs. Control: 9.091% (34/374), OR: 0.41, 95% CI: 0.22–0.75, P = 0.004). Haematoma rates were also reduced in procedures where axillary lymph node dissection (ALND) was not performed; in the TXA group, 3.379% (22/651) developed a haematoma versus 6.623% (60/906) in the control group (OR: 0.45, 95% CI 0.27–0.77, P = 0.003). TXA administration did not impact seroma formation or infection rates. Perioperative administration of TXA may impact the incidence of haematoma in breast surgery, particularly in cosmetic procedures and procedures without ALND. Well-designed randomised studies are required to determine its true efficacy. TXA has no effect on seroma formation or infection in breast surgery. • Tranexamic acid (TXA) does not impact haematoma formation in breast cancer procedures. • TXA reduces the incidence of haematoma in cosmetic breast procedures. • TXA prescription has little impact upon seroma formation and infection rates. • TXA has not been associated with thromboembolic events in breast surgery. [ABSTRACT FROM AUTHOR]

An elderly woman with preinvasive breast cancer, atrial fibrillation, coronary artery-pulmonary artery fistula, pulmonary hypertension and Stage 4 diabetic nephropathy underwent a mastectomy and sentinel lymph node biopsy. Managing her perioperative fluid balance and anticoagulation treatment were challenging. Having a malignancy, atrial fibrillation plus underhydration will increase her risk of hypercoagulation. However, fluid overload will lead to pulmonary oedema which will decrease her oxygenation further in pulmonary hypertension. Cessation of anticoagulation also increased the risk of hypercoagulation. Anticoagulant therapy increases the risk of a perioperative wound haematoma, which may require another general anaesthesia for identification and arrest of the bleeding source and haematoma evacuation. A haematoma will also increase the risk of surgical site infection; especially as a diabetic. Her anticoagulant therapy (rivoroxaban) was stopped four days preoperatively. Her ejection fraction was 50%, with Grade II diastolic dysfunction and TAPSE 0.6 cm. Her CHA2DS2-VASc Score was 5. Perioperatively, intraarterial cannulation was connected to the FloTrac™ sensor and EV1000™ monitor. Her fluid management was monitored using goal directed (GD) fluid therapy. The patient underwent surgery successfully and her anticoagulant therapy was recommenced 14 days postoperatively. [ABSTRACT FROM AUTHOR]

BACKGROUND Severe fever with thrombocytopenia syndrome (SFTS) is a new infectious disease characterised by thrombocytopenia and a bleeding phenomenon. The infection can be transmitted by contact with the athlete patient's blood and/or blood-contaminated secretions. In clinical settings, nursing care of these athlete patients is inherently challenging owing to the risk of transmission of infection. CASE SUMMARY We report a rare case of an SFTS athlete patient who developed an injection-site haematoma (3 cm × 3 cm) with local oozing 72 hours after intradermal injection of piperacillin sodium and tazobactam sodium. The treatment was aimed at stopping the bleeding, resolution of haematoma to relieve pain and prevention of infection to medical personnel. The athlete patient was isolated in a single room. An elastic bandage was applied locally to stop the bleeding, and the forearm was elevated. After the cessation of bleeding, freshly-cut thin potato slices were applied externally and wrapped with plastic wrap during the day, whereas 3M hydrophilic dressing was applied externally at night. With this treatment method (new triple therapy), the athlete patient's haematoma dissipated and the skin healed after one week. CONCLUSION The novel triple therapy for post-injection haematoma in an athlete patient with SFTS was found to be convenient, safe and effective. [ABSTRACT FROM AUTHOR]

Thromboembolic disease (TED) is an important health problem in Europe due to its high morbimortality. Pharmacological prevention is achieved with low-molecular-weight heparin (LMWH), among other strategies, which are supported by a high degree of evidence in the scientific literature. According to its safety data sheet, this injection produces local injuries at a rate of 0.1–1% after administration; however, these percentages are much lower than others reported in several studies focusing on LMWH (44–88%). This high incidence of injuries might be associated with procedural or individual variables. (1) Background: Among the most frequent side effects after the administration of LMWH are pain and haematomas (HMTs), which are influenced by obesity. We aimed to determine the relationship between abdominal skinfold (ASF) value and incidence of HMTs. In addition, I sought to determine how the risk of HMT changed with each mm increase in ASF. (2) Methods: A cross-sectional descriptive study developed in the hospital unit of orthopaedic and trauma surgery was conducted over one year. All participants in the sample were classified based on their ASF and the appearance and area of HMTs were assessed after the administration of enoxaparin. The STROBE checklist was used to evaluate the study. Descriptive statistical analysis and analysis of variance of non-parametric factors were carried out. (3) Results: In a sample of 202 participants (808 Clexane injections), more than 80% presented HMTs. More than 70% of the sample was overweight and more than 50% had an ASF > 36 millimetres (mm). (4) Conclusions: An ASF over 36 mm confers a higher risk of developing HMTs: with each mm increase in the ASF, the risk increases by 4%. Participants who are overweight or obese also present a higher risk of HMT, and these conditions correlate positively with the area of the HMTs. Providing education for the self-administration of the drug after discharge and information about the probability of suffering from local injuries in a more individualised way will lead to fewer primary care nursing consultations, more adherence to the antithrombotic treatment, and, as a consequence, a decrease in TED and health costs. [ABSTRACT FROM AUTHOR]

Fiona Kabagenyi,1 Rym Hidour2 1Department of Ear Nose and Throat, Makerere University, Kampala, Uganda; 2Department of Ear Nose and Throat, Mulago National Referral Hospital, Kampala, UgandaCorrespondence: Fiona Kabagenyi, Department of Ear Nose and Throat, College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda, Tel +256774150102, Email kabagenyiatwooki6@gmail.comAbstract: Bleeding into the retropharyngeal region in children is an unusual cause of acute upper airway obstruction. Even in the absence of known risk factors or aetiology, this rare entity should be considered as one of the differential diagnoses of retropharyngeal swellings in children. Prompt surgical intervention is required whenever rapid progression to airway obstruction is observed. In this case report, we present an 18-month-old girl previously managed as upper respiratory tract infection, who presented with progressive dysphagia, drooling and eventually airway obstruction with stridor and respiratory distress. Conservative prolonged airway protection by intubation or tracheostomy was averted by an emergency incision and drainage of the haematoma. There was complete resolution by the second week and no recurrence reported at follow-up 18 months later.Keywords: retropharynx, cervical, haematoma, oedema, paediatric

Abstract Background Chronic subdural haematoma (CSDH) is a common neurological condition affecting the elderly with decreased quality of life. Recurrence leads to increase in number of hospital admissions and surgical interventions. Several factors contribute to recurrence of chronic subdural haematoma, and determination of these factors will help institute measures to reduce recurrence of CSDH, cost of care and improved quality of life. The aim of this study was to determine the predictors of recurrence of chronic subdural haematoma in a cohort of patients presenting in a Sub-Saharan African Teaching Hospital. Methods A prospective hospital-based cohort study of 62 participants who presented with CSDH and underwent burr-hole and drainage at the Neuroscience unit of the Korle-bu Teaching Hospital. The primary outcome of this study was the recurrence of CSDH within 3 months after the surgery. Data was entered into Microsoft Excel 2016 and exported to International Business Machine (IBM) Statistical Package for the Social Sciences (SPSS) version 21.0 for analysis. Predictors of recurrence of CSDH were determined using logistic regression with odds ratio calculated at the 95% confidence level and a p-value less than 0.05 accepted as statistically significant. Results There was a male preponderance of 45 (72.6%), over females of 17 (27.4%). The mean age was 63.1 ± 13.6 years. The recurrence rate of CSDH was 21.0% whilst the mortality rate was 4.8%. Facial palsy and dysphasia were associated with the recurrence of CSDH (p = 0.045, 0.029). Hypertension and bilaterality were associated with recurrence of CSDH from a univariate analysis (p = 0.039, OR = 4.865, CI = 0.975–24.285; p = 0.005, OR = 5.979, CI = 1.585–22.557). In a multivariate logistic regression analysis, bilaterality was the only independent predictor of recurrence of CSDH (p = 0.030, AOR = 5.47, CI = 1.18–25.34). Conclusions Both hypertension and bilaterality showed statistically significant association with recurrence of CSDH. However, only bilaterality proved to be an independent predictor of recurrence of CSDH in patient who underwent burr-hole and drainage.

Sinonasal organised haematoma (SOH) is an uncommon, benign condition that can be locally aggressive. SOH can be mistaken for a malignant tumour but the characteristic imaging findings and histopathology facilitate the diagnosis of an organised haematoma. We report a 26 year old male patient presenting with unilateral nasal obstruction and painless epistaxis, which are the most common presenting symptoms of sinonasal tumour lesions. Based on the clinical features, age, radiological investigation, intraoperative finding, location of the lesion and histopathological examination; a diagnosis of SOH was arrived at. Surgical excision utilized the COBLATION technology and endoscopic complete removal of the nasal mass was done. Intraoperatively minimal bleeding was encountered. On histopathology, haematoma at the center and fibrosis at the periphery was noted. To our knowledge, this is the first reported case of SOH excision using Coblator. No recurrence was seen in subsequent follow ups. Although SOH can be mistaken for a malignant tumour, the characteristic imaging and histopathology findings facilitate the diagnosis of an organised haematoma. [ABSTRACT FROM AUTHOR]

Background: Little is known about the incidence of haematoma, and clinical correlates among orthogeriatric patients. Aims: This study aims to describe the incidence of haematoma after surgical repair of hip fracture and to identify the clinical correlates of haematoma among orthogeriatric patients. Methods: Two orthopaedic surgeons and a dedicated operator using ultrasound technique, each other in blindness, evaluated 154 orthogeriatric patients during their hospital stay. All patients received a comprehensive geriatric assessment. We investigated the concordance between clinical diagnosis and ultrasound detection of haematoma, and then we explored the clinical correlates of the onset of post-surgical haematoma. Results: Blood effusion at the surgical site was detected in 77 (50%) patients using ultrasound technique; orthopaedic surgeons reached a clinical agreement about post-surgical haematoma in 18 (23%) patients. The sensitivity of clinical evaluation was 0.66, and the specificity was 0.70. Independent of age, clinical, pharmacological, and surgical confounders, proton pump inhibitors (PPIs) were associated with post-surgical haematoma (OR 2.28; 95% CI 1.15–4.49). A tendency towards association was observed between selective serotonin reuptake inhibitors and post-surgical haematoma (OR 2.10; 95% CI 0.97–4.54), Conclusions: Half of older patients undergoing surgical repair of proximal femoral fracture develop a post-surgical haematoma. Clinical assessment, even if made by senior orthopaedic surgeons, underestimates the actual occurrence of post-surgical haematoma compared to ultrasound detection. Ultrasound technique may help to detect haematoma larger than 15 mm better than clinical assessment. PPIs's use is a risk factor for post-surgical haematoma independent of several medical and surgical confounders. [ABSTRACT FROM AUTHOR]

Introduction: Spontaneous intracerebral haemorrhage (ICH) is a rupture of blood vessels in the brain parenchyma, in the absence of any underlying structural vascular lesion. It's destructive and associated with a high mortality rate. There is a specific threshold of hematoma evacuation to impact mortality or functional outcome in ICH even the curative effect of minimally invasive hematoma removal for cerebral haemorrhage has not been fully recognized worldwide. We aim to evaluate surgical performance on hematoma volume and functional outcomes of patients. Methods: This study is a retrospective and observational clinical study. A total of 30 ICH patients were treated in the Department of neurosurgery at the Hospital of Mali from December 2019 to November 2020. Minimal invasive puncture hematoma removal was performed in all the patients. The modified Rankin scale (mRS) was used to assess functional outcomes at 6 months and one year of surgery. Was considered poor functional outcome mRS >3. The percentages (%) of the count data were assessed by Fisher's exact test by SPSS 23.0 software was used. Results: A total of 23 ICH patients met the inclusion criteria, the mean was 47,78 years. Among the risk factors, the HTA is present in 91,3% of patients. The evacuation was satisfactory in 91.30% of cases. Conclusion: This first study of minimally invasive stereotaxic for ICH evacuation must be followed up and encouraged. Even if the results are satisfactory, a double-blind study is required in the largest sample. [ABSTRACT FROM AUTHOR]

An 11‐year‐old Arabian mare was presented to the Veterinary Teaching Hospital, Koret School of Veterinary Medicine because of acute colic. During exploratory laparotomy, a segment of the jejunum was found to be necrotic, with a haematoma on its antimesenteric border. The segment was removed via hand‐sewn resection and anastomosis, and the mare recovered successfully. Histopathology revealed intramural haematoma located in the tunica muscularis. Three years later, the mare is healthy, and is back to its intended use as a brood mare. [ABSTRACT FROM AUTHOR]

COVID-19 is an unpredictable disease that can lead to multiorgan dysfunctions. There is a high frequency of venous and arterial thrombosis, among other symptoms,. Spontaneous bleeding in COVID-19 patients has also been described, but rarely, whether or not they are on anticoagulant therapy. We report a case of a 65-year-old female COVID-19 patient treated in our hospital. During the hospitalisation, she experienced sudden, severe pain in the lower part of the abdomen and had signs of hemorrhagic shock. CT of the abdomen and pelvis revealed a spontaneous giant haematoma of the anterior abdominal wall. A surgical procedure was done. We identified spontaneous bleeding in the muscles of the anterior abdominal wall. The patient recovered well. Rapid diagnosis and timely intervention are crucial to ensure a good patient outcome.

Introduction: Spontaneous intracerebral haemorrhage (ICH) is a rupture of blood vessels in the brain parenchyma, in the absence of any underlying structural vascular lesion. It’s destructive and associated with a high mortality rate. There is a specific threshold of hematoma evacuation to impact mortality or functional outcome in ICH even the curative effect of minimally invasive hematoma removal for cerebral haemorrhage has not been fully recognized worldwide. We aim to evaluate surgical performance on hematoma volume and functional outcomes of patients. Methods: This study is a retrospective and observational clinical study. A total of 30 ICH patients were treated in the Department of neurosurgery at the Hospital of Mali from December 2019 to November 2020. Minimal invasive puncture hematoma removal was performed in all the patients. The modified Rankin scale (mRS) was used to assess functional outcomes at 6 months and one year of surgery. Was considered poor functional outcome mRS >3. The percentages (%) of the count data were assessed by Fisher’s exact test by SPSS 23.0 software was used. Results: A total of 23 ICH patients met the inclusion criteria, the mean was 47,78 years. Among the risk factors, the HTA is present in 91,3% of patients. The evacuation was satisfactory in 91.30% of cases. Conclusion: This first study of minimally invasive stereotaxic for ICH evacuation must be followed up and encouraged. Even if the results are satisfactory, a double-blind study is required in the largest sample.

Abstract Purpose : Patients with Extradural (EDH) and Acute Subdural Haematomas (ASDH) represent a subgroup of head-injured patients that gain the most from timely treatment. While treatment times for head injury overall improved since the introduction of Major Trauma Centres (MTCs), no data exists describing how the time to treatment of EDH and ASDH has changed. We, therefore, compared the evacuation of ASDH and EDH before and after the implementation of a major trauma network. Methods : Data was collected prospectively between 1 May 2006 to 31 May 2007 and 1 March 2014 to 31 March 2016. The study was carried out at University Hospital Southampton, designated MTC in 2012. Patients over 18 with ASDH or EDH requiring emergency surgery were included. Results : The median time (IQR) for decompression was 4.8h (3.9–6.6) in 2006-7 and 4.4h (3.4–5.9) in 2014–16, p = 0.386. The proportion treated within 4 hours was 32% in 2006–7, and 33% in 2014-16 (p = 1.000). Analysis showed a decrease in time for CT scan (p = 0.01) and acceptance by neurosurgery (p < 0.001). There were increases in time for transferring to hospital (p = 0.005), awaiting operating theatre (p = 0.005), and operative time (p = 0.018). Conclusions : Since the introduction of MTCs, there has been no significant reduction in time to treat this select group of patients despite reductions in time to treatment of most other trauma and head-injured patients. This may be because parts of the pathway have improved, but others haven’t. It is also possible that while previously head injury was poorly served, resources were prioritised to this group so finding further gains is difficult. [ABSTRACT FROM AUTHOR]

Introduction: Carotid endarterectomy (CEA) for symptomatic stenosis reduces further stroke risk. Post-CEA haematoma increases the risk of complications including stroke. There are few studies considering protocols aimed at reducing post-CEA haematoma rates. Presented are the outcomes of a protocol developed to reduce this surgical complication. Method: The protocol was implemented in 112 consecutive CEA. It involves stepwise additional measures to ensure haemostasis before wound closure. Attention to bleeding points is followed by light compression for 10 min. Protamine is then given if haemostasis has not been achieved. If after 20 min the problem persists Tranexamic acid is given. Following a further 20 min if haemostasis is not yet achieved a platelet transfusion is undertaken. Haematoma rates, return to theatre for post-operative haematoma and other complications were compared with 100 consecutive pre-protocol introduction CEA cases. Results: Of 112 CEA patients, 19 received protamine, 8 protamine and tranexamic acid. One case required platelet transfusion. Neck haematoma rate fell from 10 to 3 cases (P =.02, OR: 0.25 [95% CI.07-.94]), of which returned to theatre for haematoma evacuation fell from 6 to 1 case (P =.03, OR: 0.14 [95% CI.02-1.19]). 30 day stroke and death rate reduced from 5% to 1.8% (P =.11, OR: 0.35 [95% CI.07-1.82]). Conclusion: The stepwise haemostasis intraoperative protocol can reduce post-CEA haematoma rates. [ABSTRACT FROM AUTHOR]

Purpose: To assess the efficacy and safety of a low-dose, computed tomography (CT)-guided transthoracic biopsy of lung and pleural lesions. Material and methods: A total of 135 low-dose, CT-guided transthoracic lung and pleural lesions biopsies were performed. A cutting needle was utilized in 124 cases, and fine needle aspiration biopsy was performed in 14 cases. In all cases, 14- to 22-gauge biopsy needles were used. Results: Diagnostic material was obtained in 111 (82.2%) patients. In 97 (71.8%) cases neoplastic lesions were found, predominantly adenocarcinoma and non-small cell carcinoma. In 14 (12.6%) cases non atypical cells were reported. Biopsy failed to obtain material suitable for histopathological examination in 24 (17.7%) cases. Complications occurred in 31 patients, including pneumothorax in 28 patients and haematoma in 3 cases. Conclusions: Based on the obtained results, it can be stated that low-dose, CT-guided transthoracic biopsy of lung and pleural tissues is an accurate and safe procedure. Also, it is linked to a low risk of complications such as a small pneumothorax. [ABSTRACT FROM AUTHOR]

Background & objectives: The information available regarding delayed adverse donor reactions (D-ADRs) is limited. Proactive follow up of donors for delayed reactions is not done routinely. This study was undertaken to analyze frequency and type of D-ADRs in whole blood donors as also the contributory factors. Methods: In this prospective observational study, all eligible whole blood donors were contacted telephonically twice (24 h and 2 wks after donation) and asked about general health and ADR specific questions. The International Society of Blood Transfusion standard guidelines were used to categorize ADRs. Results: The ADR data of 3514 donors were analyzed in the study. D-ADRs were more common as compared to immediate delayed adverse donor reactions (I-ADRs) (13.7 vs. 2.9%, P<0.001). The most common D-ADRs were bruises (4.98%), fatigue or generalized weakness (4.24%) and sore arms (2.25%). D-ADRs were more common in first time donors as compared to the repeat blood donors (16.1 vs. 12.5%, P=0.002). Females were more prone to D-ADRs (17 vs. 13.6%). Localized D-ADRs were more frequent as compared to systemic D-ADRs (P<0.001). Repeat donors had a lower incidence of systemic D-ADRs (4.11% vs. 7.37%, P<0.001). Interpretation & conclusions: D-ADRs were more common than I-ADRs with a different profile. First time, female and young donors were more prone to D-ADRs. These categories need special care at the time of blood donation. Active follow up of blood donors should be done from time to time to strengthen donor safety. [ABSTRACT FROM AUTHOR]