Cureus最新文献

Background Tissue gliding and mobility are crucial for the success of penile procedures, as postoperative adhesions can lead to painful tethering of tissues, including nerves. While most commercially available options are not designed to reduce friction and/or often have inconsistent bioresorption, a novel hyaluronic acid/alginate hydrogel represents a significant advancement in reducing postoperative tissue adhesions. This study aimed to evaluate its intra-operative application in pediatric and adult urologic surgeries with associated indications and postoperative outcomes (re-admission, re-operation, complications). Methods A retrospective review of 142 male patients undergoing urologic procedures by a single surgeon between October 1, 2022, and October 1, 2023, was conducted after IRB approval. The hydrogel was applied intra-operatively at the surgical site prior to closure. Data on demographics, preoperative diagnoses, and postoperative outcomes were extracted from a prospectively maintained registry and verified through chart review. Diagnoses included 376 conditions such as penoscrotal webbing, hidden penis, and phimosis. Outcomes, including complications, readmissions, and reoperations, were evaluated over an eight-week follow-up period. Descriptive statistics summarized the data and visual tools were used for analysis. Results The cohort comprised 142 male patients, predominantly pediatric (93.7%), with the majority (60.0%) under 1 year of age. A total of 376 urologic diagnoses were recorded, with the most frequent being penoscrotal webbing (94 cases, 25.0%), hidden penis (73 cases, 19.4%), and phimosis of the penis (61 cases, 16.2%). Less common diagnoses included hypospadias (6 cases, 1.6%) and various rare conditions with a frequency of 0.27%. Postoperative outcomes showed no complications, re-admissions, or re-operations among the entire patient cohort. Conclusion Intra-operative application of a hyaluronic acid/alginate hydrogel in pediatric and adult urologic procedures demonstrates its safety and potential utility in minimizing postoperative tissue adhesions and complications. Further study is warranted to confirm these findings and explore additional applications of this material.

Aim: Subclinical hypothyroidism (SCH) is frequently observed in patients with type 2 diabetes mellitus (T2DM) and may exacerbate macrovascular complications due to its impact on metabolic and thyroid function parameters. This study aims to explore the association between varying levels of thyroid-stimulating hormone (TSH) and the risk of macrovascular complications, alongside analyzing key metabolic, demographic, and clinical factors in T2DM patients with SCH.

Methods: A retrospective study was conducted at the Second Affiliated Hospital of Dalian Medical University, and data was collected from 2017 to 2023. According to their TSH levels, 305 patients were divided into three groups, which were T2DM mild SCH (TSH 4.34-6.9 mIU/L), T2DM moderate SCH (TSH 7.0-9.9 mIU/L), and T2DM severe SCH (TSH levels of 10.0 mIU/L or higher). The chi-square test was used for categorical variables, while one-way analysis of variance (ANOVA) was used for continuous variables. Univariate and multivariate binary logistic regression analysis was performed to determine the risk of macrovascular complications. Further, a statistical significance was set at p <0.05.

Results: Patients with severe SCH had the highest incidence of macrovascular complications, 19 (90.5%), followed by moderate SCH 38 (80.9%) and mild SCH 142 (59.9%) (p < 0.001). Multivariate analysis revealed a 4.35-fold increased risk (OR: 4.352, 95% CI: 1.761-10.754, p = 0.001) for macrovascular complications in moderate SCH and a 6.08-fold increased risk (OR: 6.075, 95% CI: 1.202-30.715, p = 0.029) in severe SCH compared to mild SCH. Age group 65 and older, male sex, and severe SCH were significant predictors of macrovascular complications. Peripheral artery disease (PAD) and coronary artery disease (CAD) were particularly associated with severe SCH (OR: 5.913, p < 0.001; OR: 3.268, p = 0.013, respectively).

Conclusion: T2DM patients with severe or moderate SCH are at significantly higher risk of macrovascular complications, especially PAD and CAD. Timely intervention and close monitoring of TSH levels, particularly in older and male patients, are essential to mitigate these risks.

Locally advanced head and neck squamous cell carcinoma (HNSCC) is treated with definitive concurrent chemoradiation if deemed unresectable. Contrarily to the metastatic/recurrent setting, there is no current role for immunotherapy in the locally advanced setting, all trials being negative in their primary endpoints. As such, and although it may still be performed, determination of programmed death-ligand 1 (PD-L1) is not mandatory in locally advanced disease. We aimed to assess if there was any correlation with PD-L1 positivity (when obtained), disease characteristics, and recurrence-free survival in unresectable, locally advanced HNSCC eligible for concurrent chemoradiation in a Portuguese centre. We retrospectively analysed 164 patients for five years, most of whom had unresectable stage IV disease treated with cisplatin-based chemoradiation. PD-L1 was determined in 35% of patients. While it did not correlate to anatomical disease location, treatment tolerance, p16 status, or clinical staging at diagnosis, PD-L1 over-expression seemed to identify a group of patients in which recurrence-free survival was shorter, highlighting the need for continued clinical trials assessing the role of PD-L1 testing and immunotherapy in this setting.

Medical and surgical treatment in patients with intellectual disabilities (IDs) presents a challenge to physicians and surgeons alike, as informed consent and longitudinal treatment are difficult to achieve. Severe constipation has a high prevalence in persons with IDs and is found in this population at a rate almost double that experienced by the general population. This case report highlights a middle-aged male with severe IDs, who presented with abdominal distention and behavior consistent with abdominal pain from constipation. The patient was found to have severe, chronic constipation, with an associated large, calcified fecalith in the rectum and an impressively expanded sigmoid and descending colon, secondary to a massive, chronic fecaloma. Resolution of the cause of constipation could not be achieved due to a combination of social factors, thereby highlighting the importance of advocating for and developing long-term treatment plans for prevention in such patients.

Curative-intent radiotherapy for multiple lung metastases with more than 10 lesions is limited by lung dose constraints and respiratory motion. Carbon ion radiotherapy (CIRT) leverages the Bragg peak for precision and hypofractionation, while high-frequency oscillatory ventilation (HFOV) minimizes motion under anesthesia. This study evaluates the feasibility of combining CIRT and HFOV in treating ≥15 lung metastases. Two patients received single-fraction CIRT (50 Gy(RBE)) targeting all lesions. Case 1 (16 metastases of bilateral lung, hepatocellular carcinoma) and Case 2 (15 metastases of the left lung, colorectal adenocarcinoma) underwent four-dimensional (4D)-CT simulation with HFOV and CIRT in one single dose. Diaphragm motion reduced from 1.15 and 3.09 cm for Cases 1 and 2 (free-breathing) to 0.1 and 0.2 cm, respectively. Lung dose constraint parameters (V30: 3.57% to 12.35%; V20: 6.06% to 15.3%) met safety thresholds. Both patients achieved 22-month survival with continued local control (complete response in Case 1; partial response in Case 2). Case 1 developed grade II pneumonitis (resolved with steroids) and asymptomatic fibrosis; Case 2 had no toxicity. Some new lesions were managed with additional CIRT. Outcomes compare favorably to published photon trials in which up to 10 lung lesions were irradiated, underscoring CIRT's precision and HFOV's motion control. Success relied on three factors: CIRT's dosimetric advantages, HFOV-driven motion reduction, and anesthesia-enabled tolerability of the longer irradiation time span. Despite cost barriers, CIRT seems to extend survival in patients with multiple lung metastases that were refractory to conventional local therapy. This approach demonstrates the feasibility of irradiating more than 15 lesions in patients with polymetastatic lung disease, offering durable control with manageable toxicity. Larger studies are needed to validate its role in multimodal therapy.

Chronic kidney disease (CKD) complicates anticoagulation in transcatheter aortic valve replacement (TAVR) patients in some cases. The aim of this review was to compare the efficacy and safety of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) in this group. We conducted a meta-analysis of 13 studies (32,508 patients) from databases like PubMed, MEDLINE (Medical Literature Analysis and Retrieval System Online), Embase, and Cochrane Library up to September 2024, focusing on all-cause mortality and major bleeding as primary outcomes, with stroke and intracranial hemorrhage as secondary outcomes. DOACs were found associated with reduced mortality (risk ratio (RR): 0.90, 95%CI: 0.81-0.99, p=0.04), particularly in moderate CKD (RR: 0.94, 95%CI: 0.90-0.98, p=0.01). Major bleeding was significantly lower with DOACs in moderate CKD (RR: 0.70, 95%CI: 0.50-0.98, p=0.03), alongside decreased stroke (RR: 0.42, 95%CI: 0.18-0.97) and intracranial hemorrhage (RR: 0.58, 95%CI: 0.36-0.94). DOACs demonstrate superior efficacy in reducing mortality and comparable safety to VKAs in CKD patients post TAVR, especially in moderate CKD. These findings advocate for DOACs as a preferable anticoagulation strategy, with cautious application in severe CKD pending further research.

Rib fractures are commonly associated with pulmonary complications; however, they may occasionally cause retroperitoneal hemorrhage, which is a rare but life-threatening condition. We report the case of a 77-year-old male individual who presented with profound hemorrhagic shock after a fall. Imaging revealed fractures of the right 11th and 12th ribs with associated retroperitoneal hemorrhage. Despite a negative focused assessment with sonography for trauma, contrast-enhanced computed tomography revealed active vascular extravasation, necessitating emergency transcatheter arterial embolization. Hemostasis was achieved using n-butyl-2-cyanoacrylate, resulting in rapid stabilization and recovery. This case underscores the importance of considering retroperitoneal hemorrhage in patients with lower rib fractures and shock, particularly when the focused assessment with sonography for trauma findings is negative. This study also highlights the role of contrast-enhanced computed tomography and transcatheter arterial embolization in diagnosis and management, demonstrating the need for a multidisciplinary approach to trauma care.

[This corrects the article DOI: 10.7759/cureus.50709.].

Limb amputation can impose severe burdens on the individual and society. Regardless of the underlying cause of amputation, pain management is challenging and may impact patients' recovery and quality of life. Individuals undergoing major lower extremity amputation (MLEA) face significant perioperative risk. Therefore, anesthesiologists must meticulously customize their anesthetic approach. Regional anesthesia (RA) provides numerous physiological advantages over general anesthesia (GA) and is essential for pain management in orthopedic surgeries, standing as an excellent anesthesia method for high-risk patients and being fundamental in multimodal analgesia. This narrative review is an attempt to enhance understanding of different pain phenomena following limb amputation and to provide a critical synthesis of the existing evidence concerning the efficacy and impact of RA on morbidity, mortality, and pain management following MLEA, aiming to shed light on areas that have not received enough attention within these aspects and subsequently serve as a guide for future research. Despite the persistent controversy regarding the comparative mortality rates associated with RA versus alternative anesthetic methods for MLEA, several studies praise their efficacy in pain management and in mitigating adverse perioperative outcomes. Given that much of this data originates from retrospective studies, randomized multicenter prospective trials remain essential to validate their actual efficacy. A comprehensive analysis of the impact of RA on healthcare costs and resources related to MLEA is necessary to determine its correlation with cost reduction, decreased hospital stays, improved resource allocation, and increased patient satisfaction.