Search Results (3,898)

Damage control surgery (DCS) is a staged surgical strategy for rapid control of life-threatening bleeding, followed by physiological stabilization and delayed definitive repair. Abdomino-pelvic packing (APP)—placing compressive material within the pelvis and/or abdomen to tamponade bleeding—is a cornerstone of DCS as a temporizing measure to achieve hemostasis and stabilization in critically unstable patients. This narrative review synthesizes current evidence on DCS with a focus on APP—a technique historically developed in trauma and orthopedic surgery for exsanguinating pelvic bleeding but adaptable to gynecologic and obstetric emergencies. We outline the historical evolution, physiological basis, and stepwise protocol of DCS, adapted to specialty-specific conditions such as postpartum hemorrhage, placenta accreta spectrum, uterine rupture, and hepatic rupture in HELLP syndrome, as well as oncologic surgeries (debulking, exenteration, lymphadenectomy) and benign procedures (trocar-entry injuries in laparoscopy, presacral bleeding in sacrocolpopexy, and retroperitoneal hemorrhage in deep-infiltrating endometriosis). Modern adjuncts—including early tranexamic acid, topical hemostatic agents, and multidisciplinary coordination—have transformed packing from a last-resort maneuver into an integrated component of staged hemorrhage control. In OB/GYN, APP allows for successful hemostasis in 75–90% of cases, with significantly lower mortality rates than trauma surgery. In conclusion, APP as a potentially life-saving maneuver within DCS requires integration into standardized, institution-wide hemorrhage protocols in OB/GYN. Training, simulation, and guideline adoption are critical, particularly in resource-limited settings where advanced interventions for catastrophic bleeding are inaccessible. Full article

This narrative review addresses the complexities of managing the vertical dimension of occlusion (VDO) in restorative dentistry, focusing on predictability in prosthetic reconstructions. Altering VDO impacts biological, biomechanical, esthetic, and functional aspects, making it a controversial topic. While VDO naturally evolves throughout life, interventions require careful consideration due to potential complications. Various techniques guide VDO determination, including facial proportions, physiological methods, phonetics, and cephalometric analysis. Clinicians must understand these principles and adapt them to individual patient needs. Materials and Methods: A narrative literature review was conducted using PubMed, Scopus, Google Scholar, and the Cochrane Library, searching keywords like “vertical dimension of occlusion”, “dental”, “diagnosis”, “management” and “complications”. In addition to the literature review, two case reports with extensive prosthodontic restorations were included to illustrate the diagnostic challenges and treatment considerations in a clinical setting. Results: Increasing VDO aids restorative treatments, re-establishing morphology, and facilitating additive procedures. Minimally invasive approaches, provisional restorations, and fixed restorations with functional contours are favored. Individualized, patient-centered care is critical, recognizing unique anatomical and functional needs. This approach optimizes stomatognathic system rehabilitation while preventing adverse effects on body posture and airway dimensions. Conclusions: To ensure predictable results and minimize risks, changes in VDO should be kept to a minimum to achieve dentofacial aesthetic harmony and secure adequate space for the planned restorations The two case reports presented, with different clinical approaches, underline the importance of understanding the potential risks and benefits of VDO alteration which is crucial for achieving predictable and successful outcomes in complex restorative cases. Full article

Background: Fulminant idiopathic intracranial hypertension (IIH) is a rare and vision-threatening variant of IIH, characterized by rapid visual deterioration and a high risk of irreversible blindness. Urgent intervention is required to prevent permanent optic nerve damage. Cerebral transverse venous stenting (CTVS) has emerged as an effective treatment for medically refractory IIH, but data on its use in fulminant cases remain limited. Methods: A retrospective consecutive cohort study was conducted at a tertiary center and included all patients with fulminant IIH diagnosed by modified Dandy criteria, with bilateral transverse sinus stenosis > 50% and a trans-stenotic pressure gradient ≥ 8 mmHg on venography. Before stenting, patients received high-dose acetazolamide (up to 3000 mg/day) and IV methylprednisolone (1000 mg/day × 3). Neuro-ophthalmic assessment included BCVA, Ishihara color vision, pupillary exam, disc edema grading, Humphrey visual fields, and optical coherence tomography (OCT). Follow-up occurred at baseline (admission), 1 week, 1 month, 3 months, and 12 months. Results: Five young female patients underwent successful CTVS without peri- or post-procedural complications. Significant improvement in headache and stabilization or recovery of visual function were observed in all patients. OCT revealed early retinal nerve fiber layer thinning within one week, preceding clinical resolution of papilledema. Conclusions: Emergent CTVS appears to be a safe and effective vision-preserving procedure in fulminant IIH, offering rapid intracranial pressure reduction and early neuro-ophthalmologic improvement. OCT may serve as a useful early predictor of treatment success, supporting its role in post-procedural monitoring. Larger prospective studies are warranted. Full article

Background/Objectives: Transcatheter aortic valve implantation (TAVI) is a standard treatment for severe aortic stenosis, especially in older adults and high-risk patients. However, many TAVI candidates have osteopenia or osteoporosis, indicated by low bone mineral density (BMD), which is linked to frailty and adverse outcomes. Although prior research suggests an association with poor clinical outcomes, data remain limited. We investigated the impact of osteopenia on TAVI outcomes, hypothesizing that a lower BMD is associated with poor perioperative outcomes and decreased long-term survival. Methods: In this single-center retrospective study, we analyzed data from 411 patients who underwent TAVI at Yamaguchi University Hospital from 2014 to 2024. Clinical and survival data were collected, and Cox regression analysis was used to identify independent predictors of mortality. Preoperative BMD was measured using computed tomography, defining osteopenia as <135 Hounsfield units at L1. Patients were categorized as having mild, moderate, or severe osteopenia. Results: Early clinical outcomes and procedural success were similar; however, patients with osteopenia had longer intensive care unit stays (p = 0.04) and higher late cardiac mortality (p < 0.001). Six-year survival was 36.2% and 88.1% in patients with and without osteopenia, respectively (p < 0.0001). Cox regression analysis revealed osteopenia as a mortality risk factor (hazard ratio: 6.75, 95% confidence interval: 2.96–15.38, p < 0.0001). Severe osteopenia was associated with the poorest outcomes. Conclusions: Osteopenia is an independent predictor of poor long-term survival after TAVI. These findings underscore the importance of comprehensive risk assessment, suggesting that targeted interventions may improve outcomes. Full article

Background/Objectives: This retrospective study aimed to evaluate the survival and marginal bone loss (MBL) of sloped-shoulder implants placed in the posterior mandible, and to explore the influence of both patient- and implant-related factors. Materials and Methods: All patients treated with sloped-shoulder-profile implants (Astra Tech Implant System, Dentsply Sirona, Bensheim, Germany) in the posterior mandible between 2012 and 2023 at two private clinics were included. Implant survival was analyzed with Kaplan–Meier estimates. MBL was measured from prosthesis delivery (baseline radiograph) to the most recent available radiograph. Outcomes were compared across thresholds of 0, 0.5, and 1.5 mm, which were considered radiographic success criteria. According to the 2017 World Workshop, peri-implantitis was not diagnosed solely based on MBL. Associations with potential risk factors (periodontitis, bruxism, and smoking) were explored. The study was approved by a local ethics committee (PI 106/2023); informed consent was waived due to the retrospective design and anonymization of data. Results: A total of 43 patients with 48 implants were included, with a mean follow-up of 40.1 months. The cumulative survival rate was 93.7%, with all failures occurring before 24 months. Mean MBL at the mesial and distal aspects was 0.27 mm and 0.39 mm, respectively. In 82.2% of implants, MBL remained ≤0.5 mm at a mean follow-up of 44.2 months. No statistically significant associations were found between risk factors such as periodontitis, bruxism, or smoking and implant outcomes. Conclusions: Sloped-shoulder implants in the posterior mandible showed high survival and stable marginal bone levels over the medium term. Their design may simplify treatment in oblique ridges, potentially reducing the need for GBR procedures. Full article

Patient-derived organoids (PDOs) have emerged as powerful tools in personalized medicine applicable to both non-malignant conditions and to cancer, where they are increasingly used for personalized drug screening and precision treatment strategies in part due to their ability to replicate tumor heterogeneity. They also serve as study model systems to understand disease mechanisms, pathways, and the impact of ex vivo exposures. We present a detailed step-by-step protocol for generating organoids from normal crypts, polyps, and tumors, including methods for tissue processing, crypt isolation, culture establishment, and the transition from basolateral to apical-out polarity for co-culture and exposure-based studies. The protocol also includes immunofluorescence staining procedures for cellular characterization and quality control measures. Our standardized approach successfully generates organoids from diverse colorectal tissues with high efficiency and reproducibility. This comprehensive guide addresses common technical challenges and provides troubleshooting strategies to improve success rates across different sample types. We believe that this resource will enhance reproducibility in organoid research and expand their utility in translational applications, particularly for personalized medicine approaches in colorectal cancer. Full article

Surgical aortic valve replacement (SAVR) is still the gold-standard treatment for aortic stenosis. However, the increasing use of biological prostheses, even in young patients, makes Valve-in-Valve (ViV) transcatheter aortic valve implantation (TAVI) an attractive option compared to redo SAVR, thanks to its lower invasiveness and sometimes greater safety. However, there are several technical and anatomical aspects to consider. Therefore, the aim of our review is to examine the main mechanisms responsible for the degeneration of biological prostheses and, subsequently, to analyze the hemodynamic (transvalvular gradients, patient–prosthesis mismatch, paravalvular leakage) and technical (risk of coronary obstruction, prosthetic implantation strategy) aspects that most influence the procedure’s success and long-term outcomes. To this end, we present a case we treated in order to enhance our readers’ experience with this procedure. Currently, ViV TAVI is approved for patients at high surgical risk, but it could become a valid option compared to redo SAVR; however, more clinical trials are needed to better analyze the survival differences between these two procedures. Furthermore, it remains a therapeutic strategy reserved for highly specialized centers due to the technical difficulties involved in its execution. Full article

Background: Pelvic injuries of the sacroiliac joint are unstable and require surgical intervention following high-energy trauma. In this study, we aimed to present the long-term clinical outcomes of patients with sacroiliac joint separation and sacroiliac fracture dislocation (crescent) injury. We compared the surgical interventions performed on the sacroiliac joint based on patient clinical data. Methods: By reviewing the records of 850 pelvic fractures treated in our clinic between 2000 and 2020, we identified 110 patients with sacroiliac joint injuries who were included in the study. The fractures were classified based on patient files and radiographs. The patients were categorized according to the surgical interventions performed on the sacroiliac joint into two groups: closed reduction with percutaneous iliosacral screws and open reduction with plates and screws. We further divided the patients who underwent open reduction and plate–screw fixation into anterior and posterior surgical approaches. Clinical outcomes were obtained by evaluating patients using a subjective pelvic scoring system. Additionally, complications observed after surgeries were investigated. Results: A total of 121 fractures from 110 patients were included in the study. Eleven of the patients had bilateral sacroiliac joint injuries, for which bilateral surgery was performed. The mean age of the patients at the time of injury was 35.15 years (range from 6 to 80 years). The mean follow-up period was 103.45 months (range from 16 to 253 months). According to the scoring system, the highest success rate was observed in plate–screw operations performed through the anterior approach to the sacroiliac joint, with excellent to good results in approximately 92% of patients. Both open reduction and internal fixation through the posterior approach and closed reduction and percutaneous iliosacral screw surgery yielded successful functional results, with no statistically significant difference between the methods (p = 0.880). Regarding complications, the most important problems were infections associated with plate–screw procedures using the posterior approach and neurologic injuries resulting from closed reduction screw surgery. Conclusions: Effective management of sacroiliac joint injuries requires surgical expertise and individualized treatment strategies. With appropriate technique and fixation, both open and closed surgical methods can achieve satisfactory anatomical reduction and functional outcomes. Although standardized treatment protocols may be developed, tailoring the approach to each patient is more important for optimal clinical success. Full article

Background/Objectives: This article discusses the clinical–surgical relevance of vascular anatomical variations, such as fenestrations—the division of a vessel into multiple channels that subsequently rejoin distally. Although rare in peripheral veins, these variations, which originate from the incomplete condensation of the embryonic capillary plexus, can predispose thrombosis and necessitate preoperative recognition to avert complications during routine procedures. This study aims to report a rare case of dual origin and double fenestration of the cephalic vein. Methods: During a cadaveric dissection, a variation of the cephalic vein was identified. Results: In this case, an origin of the cephalic vein was observed arising from the dorsal venous network of the hand. It exhibited a double fenestration in the forearm, where a branch of the medial cutaneous nerve of the forearm perforated it before draining into the brachial vein. The second, a proximal origin, arose from the convergence of two tributaries—one originating from the subcutaneous tissue lateral to the brachial muscle and the other from the biceps brachii muscle, forming a single trunk that drained into the subclavian vein. Conclusions: This rare variation of the cephalic vein (dual origin and fenestration) carries significant hemodynamic implications, including an increased risk of turbulence and thrombosis. The atypical anatomical relationship between the nerve and the fenestrated vein also heightens the potential for iatrogenic injuries. In-depth knowledge of such anomalies is crucial for healthcare professionals to minimize complications and optimize the success of procedures like venous access and arteriovenous fistulas, ultimately ensuring patient safety. Full article

For military missions, the helicopter is a versatile aircraft with many benefits. However, the high levels of noise radiation enable large acoustic detection ranges. For mission success, knowledge of acoustic radiation and propagation is paramount. This paper describes the results of acoustic measurements for a helicopter that is typically used for operations by the German special forces. The measurements include identification of the global noise radiation during different flight conditions, determination of the time between acoustic detection and arrival at the target location, and determination of the acoustic detection distance. Different approaches and departure procedures were executed, and the acoustic radiation was measured. Results indicate that during approaches, the most noise is generated either during the transition from steady level flight to descent/deceleration or at the end of the flare procedure. For the helicopter considered here, a left turn departure generates more noise at a target location then a right turn departure. Full article

Background/Objectives: This narrative review addresses ongoing controversies and advancements concerning ultrasound-guided peripheral intravenous (IV) catheter insertion, and the impact of ultrasound guidance on success rate, procedural time, patient and staff experience, complications and costs, as well as requirements for its use. Methods: A literature review was conducted. Results: Growing evidence suggests that ultrasound-guided insertion of peripheral IV catheter represents a superior technique across various patient populations, particularly those presenting with difficult IV access (DIVA). Key findings highlight significant improvements in first-attempt success rates, reduction of procedural complications, and enhanced patient comfort. Ultrasound-guided insertion is also associated with an increase in catheter dwell time, a reduction in repeat procedures and in central line placements, leading to improved resource utilization and the potential for substantial long-term cost-effectiveness, despite the cost of initial investment and training. However, obtaining these improvements involves a critical importance for standardized training, adherence to rigorous aseptic techniques, and generalization of the transformative impact of ongoing technological advancements in ultrasound devices. Conclusions: The collective body of evidence supports the widespread adoption of ultrasound-guided peripheral IV cannulation as an evidence-based best practice in modern healthcare. Full article

Blood transfusion is a routine yet resource-intensive medical procedure. Increasing global demand, limited donor availability, and logistical and ethical constraints have driven the search for adequate blood substitutes. Hemoglobin-based oxygen carriers (HBOCs) represent a promising class of therapeutics designed to mimic the oxygen transport function of red blood cells while overcoming the challenges of storage, compatibility, and infection risk. Despite decades of research, no HBOC has yet met all criteria for widespread clinical use. This review summarizes recent advances in the design and development of hemoglobin derivatives, with a focus on their biochemical properties, safety profiles, and oxygen delivery capabilities. We also discuss current limitations and translational barriers. The successful implementation of HBOCs could significantly improve transfusion strategies, especially in emergency medicine, military applications, and resource-limited settings. Continued innovation is essential to bring safe and effective oxygen therapeutics into routine clinical practice. Full article

Background: Catheter ablation is an established first-line treatment for supraventricular tachycardia (SVT). Traditionally, these procedures have been performed under fluoroscopic guidance. The objective of this study was to demonstrate the feasibility and safety of a completely fluoroless approach, as well as to evaluate clinical outcomes. Methods: This retrospective, single-center analysis included two patient cohorts, comprising a total of 400 patients: 200 in the main (fluoroless) group and 200 in the control (fluoroscopy) group. In the main group, ablation was performed using a 3D mapping system and intracardiac echocardiography (ICE) without the use of fluoroscopy and lead aprons. In the control group, procedures were conducted under fluoroscopic guidance. The primary outcomes were feasibility and safety. Secondary outcomes included acute procedural success, defined as non-inducibility of tachycardia, and chronic success, measured as arrhythmia recurrence-free survival during a 6-month follow-up period. Results: Completely fluoroless ablation was successfully performed in all patients in the main group (100%). Procedures were shorter in the fluoroless group (59.0 ± 25.8 min vs. 72.7 ± 34.0 min, p < 0.001), with no difference in acute success rates (100% vs. 100%). No serious complications occurred in the main group, compared to one event in the control group (0 vs. 1.0, p = 0.313). Arrhythmia recurrence rates during follow-up were similar between groups (HR: 0.877, 95% CI: 0.367–2.097, p = 0.769). Conclusions: A completely fluoroless, “apron-less” approach to SVT ablation is feasible, with complication and success rates comparable to the traditional fluoroscopy-guided approach. Full article

Background: Anastomotic leakage (AL) is a major complication after esophago-gastric surgery, with incidence rates of 11–21% and mortality up to 14%. Early intervention is essential to reduce morbidity. Endoscopic treatments have advanced, with self-expandable metal stents (SEMSs) as the traditional standard (success ~90%), but they carry risks like migration, stenosis, and need for drainage. Endoscopic vacuum therapy (EVT), applying negative pressure to drain secretions and promote healing, has shown success rates of 66–100%. Limited comparative data exists from small retrospective studies. This study compares SEMS and EVT for safety and efficacy in AL management. Methods: A retrospective case–control study from a prospective database at our institution was performed (March 2012–2025). We included patients with AL post-esophageal/gastric surgery treated endoscopically (SEMS or EVT). We excluded patients treated with conservative or surgical management. Demographics, comorbidities, oncology, surgery type, leak details, treatments, and outcomes were collected. Primary outcome was complete healing of the leak, while secondary outcomes were time to success, number of procedures needed, hospital stay, complications, mortality. Results: From 592 resections, we extracted 68 AL (11.5%), 45 of which met the inclusion criteria (22 SEMS, 23 EVT). Groups were similar demographically, but SEMS had more respiratory issues (43% vs. 8.7%, p = 0.018). SEMS were used more after esophagectomy (86.4% vs. 56.5%, p = 0.004); EVT was performed mostly after gastrectomy (34.7% vs. 9.1%, p = 0.009). Success rate was 86.4% for SEMS vs. 95.6% for EVT (p = 1.000). Complications were significantly lower in EVT (8.3% vs. 50%, p = 0.001; SEMS: 36.4% migrations, 18.2% stenoses). Leak onset time, modality of diagnosis, and leak size were comparable among the groups. Need for jejunostomy was higher in EVT (43.5% vs. 9.1%, p = 0.015), while chest drains in SEMS (63.7% vs. 13.1%, p < 0.001). Hospital stays (33–38 days, p = 0.864) and mortality (22.7% vs. 8.7%, p = 0.225) were similar. No differences were observed in terms of long-term mortality (log-rank p = 0.815). Conclusions: SEMS and EVT are both effective for AL after esophago-gastric surgery. EVT offers fewer complications and shorter treatment, so it is favored especially for esophago-jejunal leaks. Full article

For decades, regeneration of alveolar bone defects has depended on traditional grafting options, such as autogenous/allogenic grafts or allografts. Recently, extracted teeth was introduced as an alternative graft source. Tooth autografts are being used and have gained significant attention due to their biocompatibility, osteoconductivity, osteoinductivity, and osteogenic properties. Furthermore, tooth allografts have potential to act as natural biocomposites for oral regeneration procedures and might be advantageous options in near future. Recent advances in tooth banking, including cryopreservation, can serve to maintain bioactivity and to improve the safety, viability, and regenerative potential of teeth. They might be revolutionary in oral surgery, offering a more sustainable solution to the growing demand for bone regeneration procedures. Nevertheless, challenges such as immunogenic responses, ethical issues, and regulatory constraints persist. Ongoing research and technological innovation continue to address these problems. To date, the success rates of tooth autografts are promising, and they are regarded as a reliable option in clinical practice, with predictable outcomes in alveolar ridge preservation, sinus augmentation, periodontal regeneration, guided bone regeneration (GBR), and endodontic surgery by providing natural scaffolds for cell integration and bone remodeling. However, the scientific literature on tooth allografts is lacking. Therefore, this review aimed to comprehensively evaluate the scientific literature for comparing the properties of tooth grafts with other grafting options, in terms of processing techniques, and various clinical applications, positioning them as versatile biocomposites for the future, bridging material science and regenerative dentistry. Furthermore, possible applications of allogenic tooth grafts and overcoming current limitations are also discussed. Full article