Evaluation of postmyomectomy uterine scar

PURPOSE: To determine preoperative and intraoperative factors that affect the healing pattern of a myomectomy uterine incision and to estimate the incidence and outcome of postmyomectomy hematoma demonstrated with sonography. METHODS: This observational longitudinal prospective study followed the course of patients diagnosed with at least 1 leiomyomata. Each patent was scheduled for abdominal myomectomy. Preoperative assessments included sonographic measurement of the uterine volume as well as identification of the numbers and sites of the leiomyomata. Detailed operative notes were reported for every patient. Transvaginal sonography was performed for all cases on day 2, day 7, and at 1 month and 3 months postoperatively. The main outcome measure was the occurrence of postoperative hematoma versus preoperative and postoperative factors that possibly affect uterine healing. RESULTS: We found a statistically significant reduction of the uterine volume on follow-up (P < 0.001) of the 169 women enrolled. Hematoma in the myomectomy bed was observed postoperatively in 40 (24%) 28 (17%) and 12 (7%) patients on day 2, day 7, and 1 month, respectively. A preoperative myoma size greater than 110 cm(3), the use of a tourniquet, and the experience of the surgeon were significantly correlated with formation of uterine scar hematomas. CONCLUSIONS: The postoperative sonographic diagnosis of wound hematoma may be used as an indicator of wound healing that is usually complete within 3 months. Use of a tourniquet is frequently associated with hematoma formation. Myomectomy should usually be performed by an experienced surgeon without a tourniquet, using microsurgical principles, especially when the sizes of the leiomyomata exceed 110 cm(3).     

Does No-Touch Technique Better than Conventional or Intermediate Saphenous Vein Harvest Techniques for Coronary Artery Bypass Graft Surgery: a Systematic Review and Meta-analysis

Saphenous vein (SV) is a common graft being used in coronary artery bypass grafting (CABG). Conventional (CON), intermediate (I), and no-touch (NT) are the most common harvesting techniques of SV for CABG. The aim of this study is to systematically review the NT versus CON and I techniques in harvesting SV for CABG. Twelve databases were searched for randomized controlled trials comparing the CON, I, and NT techniques in harvesting SV for CABG. Twelve reports of six RCTs were included. Our meta-analysis showed that with NT technique, patency rate was significantly higher when compared to I technique up to 18-month follow-up duration. In contrast, this significant difference was not maintained in terms of minor complications of leg wounds with both techniques. The NT has significantly higher patency rate compared to I vein harvesting technique. However, more RCTs are warranted to confirm these results.     

The emerging role of the epigenetic enzyme Sirtuin-1 and high mobility group Box 1 in patients with diabetic foot ulceration

Background

Diabetic foot ulceration (DFU) is a serious diabetic complication that can progress to amputation and since SIRT1 regulates glucose metabolism, inflammation, and oxidative stress which are the major contributors in diabetic complications, So we aimed to discuss its role as an epigenetic biomarker in DFU and highlight its link to oxidative stress and inflammatory cytokines.

Tailored pancreatic reconstruction after pancreaticoduodenectomy: a single-center experience of 892 cases

BACKGROUND: Pancreatic reconstruction following pancre-aticoduodenectomy (PD) is still debatable even for pancreatic surgeons. Ideally, pancreatic reconstruction after PD should reduce the risk of postoperative pancreatic fistula (POPF) and its severity if developed with preservation of both exo-crine and endocrine pancreatic functions. It must be tailored to control the morbidity linked to the type of reconstruction. This study was to show the best type of pancreatic reconstruc-tion according to the characters of pancreatic stump. METHODS: We studied all patients who underwent PD in our center from January 1993 to December 2015. Patients were categorized into three groups depending on the presence of risk factors of postoperative complications: low-risk group (ab-sent risk factor), moderate-risk group (presence of one risk fac-tor) and high-risk group (presence of two or more risk factors). RESULTS: A total of 892 patients underwent PD for resection of periampullary tumor. BMI >25 kg/m2, cirrhotic liver, soft pancreas, pancreatic duct diameter <3 mm, and pancreatic duct location from posterior edge <3 mm are risk variables for development of postoperative complications. POPF de-veloped in 128 (14.3%) patients. Delayed gastric emptying occurred in 164 (18.4%) patients, biliary leakage developed in 65 (7.3%) and pancreatitis presented in 20 (2.2%). POPF in low-, moderate- and high-risk groups were 26 (8.3%), 65 (15.7%) and 37 (22.7%) patients, respectively. Postoperative morbidity and mortality were significantly lower with pan-creaticogastrostomy (PG) in high-risk group, while pancre-aticojejunostomy (PJ) decreases incidence of postoperative steatorrhea in all groups. CONCLUSIONS: Selection of proper pancreatic reconstruc-tion according to the risk factors of patients may reduce POPF and postoperative complications and mortality. PG is superior to PJ as regards short-term outcomes in high-risk group but PJ provides better pancreatic function in all groups and therefore, PJ is superior in low- and moderate-risk groups.     

Transconjunctival versus subciliary approach to the infraorbital margin for open reduction of zygomaticomaxillary complex fractures: a randomized feasibility study

Introduction

Although some studies addressed the differences between subciliary and transconjunctival approaches, no previous prospective comparative study on displaced zygomaticomaxillary complex (ZMC) fracture that repaired by three-point internal fixation using also upper gingivolabial incision and upper eye lid incision. So, the effect of these incisions on the comparison was not investigated.

Purpose

The purpose of this study was to compare transconjunctival and subciliary approaches for open reduction and internal rigid fixation (OR/IF) of ZMC fractures.

Methods

This prospective study was carried out on 40 patients had displaced ZMC fractures repaired by OR/IF. Patients were randomly assigned into two equal groups (20 patients for each); subciliary group subjected to subciliary approach and transconjunctival group subjected to transconjunctival approach for inferior orbital rim repair. In both groups, frontozygomatic and zygomaticomaxillary buttresses were also approached by lateral eye brow and superior gingivolabial incision, respectively. Primary outcome measures include accessibility (need for lateral canthotomy), the exposure duration, postoperative pain, early postoperative edema, and operative complications. Secondary outcome measures include dental occlusion, average intrinsic vertical mouth opening, post subciliary scar assessment, late postoperative complication, and opthalmological assessment concerning ectropion, entropion, scleral show, and eye globe affection (enophthalmos or diplopia).

Results

The mean duration from incisions to fracture exposure was 13.7 ± 2.17 min in subciliary approach and 14.6 ± 2.31 min in transconjunctival approach with nonsignificant difference (p = 0.1284). Lateral canthotomy was required for proper exposure of the fracture and OR/IF using transconjunctival approach while not needed with subciliary approach. Ectropion and scleral show occurred in 10 and 15% respectively in subciliary group and were not encountered in transconjunctival group. Although postoperative periorbital edema was significantly more sever in transconjunctival group within the first postoperative week (p = 0.028), no persistent periorbital edema was reported. Infection, hematoma, and globe complication were not detected in any patient. All authors characterized all scars of the subciliary group as unnoticeable.

Conclusion

Transconjunctival approach mostly needs lateral canthotomy that was not needed with subciliary approach. Transient postoperative edema is more in transconjunctival approach while postoperative ectropion and sclera show was detected only with subciliary approach. So, building up of experience in transconjunctival approach will be beneficial for maxillofacial surgeons and more measures to avoid ectropion are needed with subciliary approach.

     

Automation of semen analysis using flow cytometer in comparison with manual methods

In order to standardize techniques and limit the effect of human factors on the results of analyses of biological fluids, automation seems to be mandatory. In an attempt to automate semen analysis, computer assisted sperm analysis (CASA) system has been developed, however its use is still limited and its practical applications have many criticisms. In a trial to automate semen analysis, this study aimed to evaluate the usefulness of flow cytometer in the detection of some seminal parameters in comparison with the traditional manual methods. Isolated spermatogenic cells and isolated sperms from semen and EDTA blood of volunteers were analyzed by flow cytometer in order to define their respective regions. Ejaculates of 28 male patients were subjected to routine semen analyses, leucocytes detection by peroxidase test and monoclonal antibody CD53 using flow cytometer after preparation of the patients' semen samples for flow cytometeric analysis. A highly significant correlation (r=0.96, p= 0.001) of absolute neutrophils (pus cells) detected by peroxidase versus flow cytometer using CD53 monoclonal antibody. A poor correlation (r=0.39, p=0.035) of sperm counts assessed by manual technique and flow cytometer and a spurious sperm counts of 1.08 million/ml detected by flow cytometery in azoospermic patients. Flow cytometer could be used for the assessment of pus cells in semen but seems to be non reliable for the assessment of sperm count if gating depend on sperm size and granularity alone.     

Revising the criteria for the predictors of variceal haemorrhage outcome

Background and study aimsThere are many criteria and definitions used to evaluate the failure to control and prevent variceal bleeding. Baveno criteria were developed in Baveno consensus workshops I–III. Some of these criteria are fairly difficult to apply and do not adequately reflect common situations that are observed in clinical practice. Therefore, new criteria were developed at the Baveno-IV workshop. In the present study, we aimed to evaluate the validity of Baveno II–IV criteria in the prediction of bleeding recurrence among patients with liver cirrhosis who presented with bleeding oesophageal varices.Patients and methodsFifty patients with liver cirrhosis and acute variceal bleeding were divided into two groups according to treatment response. Group I consisted of 44 patients for whom treatment to control bleeding was successful, and Group II included 6 patients for whom treatment failed. Baveno criteria were used in the evaluation of treatment outcome in these patients.ResultsThe overall accuracy of Baveno II and III criteria was 87.3% within the first 6 h and 76.5% after 6 h, with a mean accuracy 81.9%. The overall accuracy of Baveno IV criteria in this study was 83%. The criterion of death was also very specific (100%), with 100% PPV, but its sensitivity was very low (16.7%).ConclusionBaveno IV criteria are less complicated, much easier to apply and have nearly the same accuracy as Baveno II/III criteria. However, there are some criteria that need to be modified, such as the adjusted blood requirement index (ABR1), among others.