Management and outcomes of penile fracture: 10 years’ experience from a tertiary care center

Objectives

To evaluate our experience on diagnosis and management of penile fractures.

Materials and methods

This retrospective study included 31 patients who were treated for penile fracture between 2002 and 2012. We analyzed the etiology of penile fracture, concomitant pathologies such as urethral injury, deep or superficial dorsal vein ruptures, treatment modalities (surgery or conservative treatment) and complications of treatment modalities.

Results

The mean age of the patients was 32 years (range, 23–47 years). In 27 patients (87 %), the cause of penile fracture was sexual intercourse. Patients presented with swelling, pain and popping or cracking sound in penis. The diagnosis of penile fracture was established clinically in all of the patients. There were no urethral injuries or dorsal vein ruptures. Ten patients who refused surgical treatment were treated conservatively and remaining 21 patients with early surgical intervention. Among conservatively treated patients, two suffered from erectile dysfunction, two from painful erection and another two from penile curvature. No serious complications such as erectile dysfunction, penile curvature or painful erection were observed in surgically treated patients.

Conclusion

Penile fracture can be diagnosed easily with history and physical examination, and favorable functional results can be achieved with early surgical repair.     

Lesson learned from 10?years’ experience in laparoscopic appendectomy in a community hospital

The debate between open and laparoscopic appendectomy is now overtook by the need of a standardized technique, as laparoscopy, in the elective and emergency setting, is widely disseminated thorough surgical practices. A retrospective review of a 10?years?? case history (838 laparoscopic appendectomies) is analyzed, and the last 5?years experience (300 cases) compared to the previous experience after the adoption of a standardized technique, which comprehends an all-comers policy without patients?? selection prior to explorative laparoscopy. No post-operative infections have been recorded, neither intra-abdominal abscesses nor wound infections, in the laparoscopic group. Significant differences (p?<?0.05) have been found between the rate of peritonitis and male sex, elderly patients, and the use of stapler for the treatment of the appendiceal stump. Also conversion to laparotomy has been associated with complicated appendicitis, while associated diseases are found more frequently in fertile women. No differences in the operating time have been evidenced between laparoscopic, open or converted appendectomy. We sustain that every patient with a suspect of appendicitis should have a laparoscopic chance, indeed maintaining a low threshold for conversion; and that surgical indication should be anticipated for male and elderly patients, in order to lower the rate of complicated appendicitis.     

Clinical outcomes of childhood lupus nephritis: a single center’s experience

This study retrospectively reviewed the medical records of children with lupus nephritis (LN) who were treated at Seoul National University Children's Hospital from 1986 to 2005 (mean duration 8.3+/-4.4 years). The records of 77 children (22 male and 55 female) were examined. The mean age at diagnosis was 11.9+/-3.0 years. The initial biopsy results revealed a WHO class IV classification for 60 (88.2%) of 68 biopsy proven cases. Of 77 patients, 67 (87.0%) responded initially to the high-dose corticosteroids with or without additional immunosuppressive therapy. Of the initial responders (67), 30 (44.8%) experienced at least one episode of proteinuric (24) or nephritic (6) flare. Thirteen patients (16.9%) progressed to either chronic renal failure (CRF) or end-stage renal disease (ESRD). Six (7.8%) patients died. A Kaplan-Meier estimate of patient survival and CRF-free survival rate was 95.4% and 88.7% at 5 years and 91.8% and 74.7% at 10 years, respectively. Multivariate analysis for class IV LN revealed male gender (P=0.029), initial hypertension (P=0.001) and absence of remission (P=0.002) to be prognostic factors predicting CRF. Glomerulosclerosis of 10% or more (P=0.005), nephritic flare (P=0.011), and presence of anti-phospholipid antibody (P=0.017) or syndrome (P=0.004) were also found to be independent risk factors for CRF. Cyclophosphamide pulse therapy failed to demonstrate superiority over other combined immunosuppressants used for the treatment of diffuse proliferative LN.     

Surgical treatment of aortoesophageal fistula induced by a foreign body in the esophagus: 40 years of experience at a single hospital

Background

Aortoesophageal fistula (AEF) is a rare but usually fatal complication of a foreign body in the esophagus. Little effective therapy exists to cure an AEF induced by esophageal foreign body. This report describes the authors’ 40 years of experience treating patients with AEF caused by a foreign body and compares different treatments of patients and their clinical outcomes.

Methods

The treatments of five patients with AEF caused by esophageal foreign body impaction were recorded at Wuhan General Hospital of Guangzhou Command from 1970 to 2011. One of these five patients was managed with nonsurgical measures, whereas three were treated by surgery with cardiopulmonary bypass, and one was treated by surgery with endovascular stent-graft repair.

Results

All five AEF cases were confirmed by computed tomography, esophagogastroscopy, surgical findings, or two or both. The nonsurgically treated patient died of fatal hemorrhage. Another patient died during the postoperative period because of ventricular fibrillation (he had a history of coronary heart disease before the operation), and still another patient died of fatal hemorrhage during the surgery. The remaining two patients were completely cured by surgery: the one via traditional open thoracotomy with cardiopulmonary bypass and the other by surgery with endovascular stent-graft repair.

Conclusions

The authors’ experience indicates that early diagnosis and an aggressive surgical treatment without delay is the only form of effective therapy for AEF. Endovascular stent-graft repair may be a safe and feasible method for treating patients with AEF that has potential as an improved treatment option for AEF.     

Should we change our approach to resuscitating victims of femoral fracture?A clinical experience in a busy trauma hospital in Shiraz,Iran

Purpose Traumatic hemorrhagic shock is a life-threatening event worldwide.Severe brain trauma accompanying femoral fractures can trigger inflammatory responses in the body and increase pre-inflammatory cytokines such as TNF-α,IL-1.The primary treatment in these cases is hydration with crystalloids,which has both benefits and complications.The purpose of this study was to investigate the effects of fluid therapy on the hemodynamics,coagulation profiles,and blood gases in such patients.Methods In this cross-sectional study,patients were divided into two groups:femoral fracture group and non-femoral group.The hemodynamic status,coagulation profile,and blood gases of patients in both groups were evaluated upon arrival at the hospital and again 2 h later.Data were analyzed by t-test and ANOVA with repeated data and paired samples t-test.Results A total of 681 trauma patients(605 men and 76 women)participated in this study,including 69(86.3%)men and 11(13.8%)women in femoral fracture group and 536 men(89.2%)and 65 women(10.8%)in non-femoral group.The laboratory parameters were evaluated in response to the equal amount of crystalloid fluid given upon arrival and 2 h later.Blood gases decreased in the fracture group despite fluid therapy(p<0.003),and the coagulation profile worsened although the change was not statistically significant.Conclusion The treatment of multiple-trauma patients with femoral bone fractures should be more concerned with the need for the infusion of vasopressors such as norepinephrine.If there is evidence of clinical shock,excessive crystalloid infusion(limited to 1 L)should be avoided,and blood and blood products should be started as soon as possible.     

Preferences of Jehovah’s Witnesses regarding haematological supports in an obstetric setting: experience of a single university teaching hospital

BackgroundJehovah’s Witnesses have been shown to be at increased risk of mortality and morbidity as a consequence of obstetric haemorrhage and refusal of blood products. Since 2004, however, Jehovah’s Witnesses have been allowed to accept minor fractions of blood at their own discretion. We sought to determine the preferences of pregnant Jehovah’s Witnesses regarding haematological supports since this policy change.MethodsThis is a retrospective observational study of consecutive Jehovah’s Witnesses attending a university-affiliated tertiary referral centre between 1 January 2007 and 31 December 2013. The main outcome measure was the proportion of women who would be willing to accept blood products and other haematological supports in the event of life-threatening bleeding, should it occur.ResultsSeventy-six Jehovah’s Witnesses attended for obstetric care during the study period. Major fractions of blood (red cells, plasma or platelets) were acceptable to 7.9% and 50% would accept some minor fractions. Some blood components were acceptable to 70.3% of nulliparous women compared to 48.9% of multiparous women. In women with advance directives some blood components were acceptable to 70.5% compared with 37.5% of those without. Recombinant factor VIIa was acceptable to 53.9%. Black African women had the lowest acceptance of any ethnic group of any blood products.ConclusionThe spectrum of acceptance of blood products is wide ranging within our obstetric Jehovah’s Witnesses population. Recombinant factors are not universally acceptable despite their identification as non-blood products. A multidisciplinary approach with individualized consent is recommended.     

Survival outcomes of Asian younger men (< 55 years) undergoing radical prostatectomy: a review of prostate cancer database in a tertiary hospital in Singapore

International Urology and Nephrology - Prostate cancer largely affects older men. This study aims to investigate prostate cancer in younger men (&lt;?55&nbsp;years) to shed light on...     

Could we prove the nursing outcomes utilising clinical data warehouse? Effectiveness of pressure ulcer intervention in Korean tertiary hospital

The use of Clinical Data Warehouse (CDW)  for research and quality improvement has become more frequent in the last 10 years. In this study, we used CDW to determine the effectiveness of pressure ulcer interventions offered by ward nurses and wound care nursing specialists. A retrospective clinical outcomes study that utilise CDW has been carried out. We identified 1415 patients who were evaluated as pressure ulcer risk group from 1 July 2019 to 31 December 2019. Kaplan-Meier survival analyses were used to estimate the time to occurrence of pressure ulcers. We compared the survival curves of each group by applying the log-rank test for significance. The overall median time to occurrence for both groups was 13 days (95% CI range: 11-14 days). The control group showed a longer median time (14 days) to occurrence than the case group (12 days). In the pressure ulcer stage I, the case group showed a longer median time (14 days) to occurrence than the control group (8 days), indicating that the intervention provided by the wound care nursing specialist was effective in stage I, and delayed the occurrence of pressure ulcers. The findings may be used as preliminary data for the utilisation of the CDW in the field of nursing research in the future. Also, facilitating the accessibility of the wound care nursing specialist in the general wards should be effective to decrease the incidence rates.     

Lean thinking: can it improve the outcome of fracture neck of femur patients in a district general hospital?

We present our experience in the management of hip fracture patients after the application of a value-stream approach, the Lean framework, in our trust. This system uses available resources in an efficient manner whilst eliminating waste. A statistically significant reduction of 5% and 9.3% was noted in the 30-day and overall mortality, respectively, after implementing ‘Lean thinking’. Further improvements were also noted in door-to-theatre time, use of trauma beds and early discharge from hospitals. To our knowledge, this is the largest study in the literature where the Lean framework has been successfully employed for the management of a very challenging health-care issue faced by the National Health Service. Future prospective studies are, however, needed to reconfirm these results and to evaluate the components that are most critical to the success of the implemented framework.     

Management of pancreatic pseudocyst in the era of laparoscopic surgery – Experience from a tertiary centre

Background In the era of minimally invasive surgery, laparoscopy has a great role to play in the management of pseudocyst of pancreas. We present our surgical experience over the past 12 years (May 1994 to April 2006) in the management of pancreatic pseudocysts. Materials and Methods The total number of cases was 108, with 76 male and 32 female patients. Age ranged from 18 to 70 years. Duration of symptoms ranged from 45 days to 7 months. Fifty-nine patients presented with pain abdomen. Sixty-one patients had co-morbid illness. Ten patients had abdominal mass on clinical examination. Predisposing factors were gallstones in 58 cases, alcohol in 20 cases, trauma in eight cases and post-pancreatectomy in one case. In 21 cases there are no predisposing factors. Results All the cases were successfully operated without any significant intraoperative complication. Laparoscopic cystogastrostomy was done in 90 cases (83.4%), laparoscopic cystojejunostomy in eight cases (7.4%), open cystogastrostomy in two cases (1.8%), and laparoscopic external drainage in eight cases (7.4%). Laparoscopic cholecystectomy was done in 47 cases along with the drainage procedure. The mean operating time was 95 minutes. Mean blood loss was 69 ml. Mean hospital stay was 5.6 days. Percutaneous tube drain to assist decompression of the cyst was kept in all the laparoscopic cystojejunostomy (LCJ) group. Two patients were re-operated for bleeding and gastric outlet obstruction. We had no mortality in the postoperative period. With mean follow up of 54 months (range 3–145 months); only one patient who underwent laparoscopic cystogastrostomy (LCG) earlier in this series had recurrence due to inadequate stoma size. This patient later underwent OCG Conclusion Laparoscopy has a significant role to play in the surgical management of pseudocysts with excellent outcome. It offers all the benefits of minimally invasive surgery to the patients.     

Management of complications arising from transvaginal mesh kit procedures: a tertiary referral center’s experience

This case series’ purpose is to review a referral center’s experience with complications from mesh kits. A chart review of 12 patients who presented with complications associated with transvaginal mesh kit procedures was performed. All patients underwent complete surgical removal of the mesh to treat mesh exposure, pain, or vaginal bleeding/discharge followed by an anterior or posterior repair. The mean follow-up time after surgery was 3.4 months. Eight of 12 patients had mesh that had formed a fibrotic band. Six of 12 patients had complete resolution of pain. Of the nine patients with mesh exposure, all required significant resection of the vaginal wall. No further mesh exposure occurred. The use of transvaginal mesh kits may cause previously undescribed complications such as pelvic/vaginal pain or large extrusions requiring complete removal. Removal of all mesh except the arms may cure or significantly improve these problems.     

The role of echo-laparoscopy in abdominal surgery: five years’ experience in a dedicated center

Background For more than 20 years intraoperative ultrasonography (IOUS) has been considered an important diagnostic tool in abdominal surgery. In the last few years, with the spread of laparoscopic surgery, echo-laparoscopy (LIOUS) has gradually replaced open ultrasonography, aiming to achieve similar results. Methods LIOUS was performed using an ALOKA 5.500 device, provided with a linear flexible laparoscopic probe that was compatible with a 10-mm port. IOUS was performed by means of a linear side-view, T-shaped or microconvex probe. The probes were sterilized with hydrogen peroxide. No water bath was used during the surgical examination, but full contact of the probe with the surface of the involved organ was always attempted. From 2001 to 2005, 36 liver resections, 40 pancreas procedures, 203 procedures for suspected common bile duct calculi, 541 colon and 82 stomach resections, and 82 adrenal surgery procedures were performed. IOUS or LIOUS was performed in 432 patients (43.8%). All livers and pancreases underwent intraoperative ultrasound, while biliary, colonic, gastric, and adrenal pathologies were selectively studied when there were doubts about the location and extension of the disease. Results IOUS and LIOUS were valuable diagnostic procedures, supplying relevant clinical information in 65.1% of the patients and modifying the surgical approach in 17.2%. LIOUS was used instead of cholangiography to study bile ducts when lythiasis was suspected, achieving high diagnostic specificity (98%) and accuracy (100%). Surgical anatomy of the bile ducts was correctly identified by LIOUS in every case. Discussion In our experience IOUS and LIOUS were of the utmost importance in better defining staging of disease, infiltration of neighboring structures, number and size of nodular lesions, and anatomy of the hepatic pedicle and intrahepatic structures, thus making it possible to more accurately plan surgical procedures.     

Complications of pediatric live-donor kidney transplantation: a single center’s experience in Egypt

Our objective was to study the complications of chronic renal failure (CRF) among pediatric live-donor kidney transplant recipients. Between March 1976 and December 2005, 1,785 live-donor kidney transplantations were carried out at our center. Of the recipients, 292 were 20 years old or younger (mean age 12.8 years, ranging from 4 years to 20 years). Clinical and laboratory parameters of these 292 patients were analyzed retrospectively. They were 182 boys and 110 girls. Patients who had received transplants before 1988 were treated with prednisolone and azathioprine as combined therapy. From 1988 to 1998, a triple regimen comprising prednisolone, azathioprine and cyclosporine A (CsA) was administered. Tacrolimus and mycophenolate mofetil (MMF) were introduced as primary therapy in 1998. Growth, anemia, infections, and surgical, cardiac, neurologic, bone and other medical complications were assessed. Triple-drug immunosuppression (prednisone + CsA + azathioprine) was used in 68.2% of transplants. Acute rejection rate was 47.6%; chronic rejection rate was 31%. Hypertension (62%) was the commonest complication. Anemia was diagnosed in 61%. A substantial proportion of patients (48%) were short, with height standard deviation scores (SDSs) of less than −1.88. The overall infection rate was high, and the majority (54%) was bacterial. Malignancy was diagnosed in eight (3%) patients. The incidence of urological complications was 14%, and that of vascular complications was 1%. Cardiac complications included left ventricular hypertrophy (LVH) in 47.9% of patients, left atrial enlargement (31.5%) and left ventricular dilatation and systolic dysfunction (13.7% for each). Neuropathic changes were found in 19% of our cases, with the distal muscles of lower limbs more affected. Other complications included avascular bone necrosis in 8% (all of them in the hip joint) and bone loss in 60% of patients. We concluded that, despite the long-term success of pediatric renal transplantation in a developing country, there is a risk of significant morbidity. The authors declare that they have no conflict of interest.     

Minimally invasive repair of pectus carinatum: a retrospective analysis based on a single surgeon’s 10 years of experience

Objectives

Over the past decade, minimal invasive surgery for correction of pectus carinatum has gained worldwide acceptance. This study reviews our clinical experience with minimally invasive repair of pectus carinatum (MIRPC) since 2008.

Methods

Between 2008 and 2018, 101 patients (77 male, 24 female) underwent correction of pectus carinatum with the MIRPC technique. The mean age of the patients was 14.7?±?4.8 (3–38) years. Over an 8 years’ experience we slightly modified the original Abramson technique. All patients presented with cosmetic complaints and all had a flexible chest wall on “compression test”. Early follow-up was on postoperative day 15 and 30.

Results

The mean operative time was 42.1?±?16.9 min. The mean hospital stay was 4.2?±?0.9 days. Postoperative complications included pneumothorax (n?=?2, 1.9%), wound infection (n?=?2, 1.9%), skin perforation (n?=?2, 1.9%), intolerable pain (n?=?1, 0.9%), skin hyperpigmentation (n?=?1, 0.9%), and overcorrection (n?=?1, 0.9%). Initial postoperative results were excellent in all patients. The bars were removed at a median of 24.8?±?4.5 months in 44 of 101 patients. 43 of 44 (97.7%) patients whose bar were removed reported excellent results.

Conclusions

MIRPC is a feasible procedure with low morbidity and excellent cosmetic results in the treatment of pectus carinatum deformities in selected patients.

     

More than 20 years’ experience of left ventricular assist device implantation at a non-transplant Centre

Objectives. Over recent decades implantable left ventricular assist devices (LVAD) have increased the possibility of improved survival in patients with advanced heart failure who also benefit from a better quality of life. The aim of this retrospective survey was to review the clinical results of LVAD implantation at a low-volume non-transplant centre (Linköping, Sweden) between 1993 and 2016. Our aim was also to assess the mortality and morbidity rates associated with implantation of three LVAD versions at our centre, and to compare our results with those from transplant centres. Design. A retrospective cohort study was performed examining the medical records of patients who had a HeartMate^® (HMI, HMII, HMIII) LVAD implanted as a bridge to heart transplantation (BTT) or as destination therapy (DT) at the University Hospital, Linköping. Results. Our main finding was a survival to heart transplantation rate of 82% among our BTT LVAD patients. The most common adverse event among our patients was infection. A higher frequency of temporary dialysis was seen in the HMII group compared to the HMI group, and the frequency of right ventricular failure was higher in our HMII material. Conclusions. Our data suggests that patients requiring long-term LVAD support can safely have their device implanted and cared for at a non-transplant centre.