Evaluation of the TraumaGuard Balloon-in-Balloon Catheter Design for Intra-Abdominal Pressure Monitoring: Insights from Pig and Human Cadaver Studies.

Introduction: Intra-abdominal pressure (IAP) monitoring is crucial for the detection and prevention of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). In the 1970s, air-filled catheters (AFCs) for urodynamic studies were introduced as a solution to overcome the limitations of water-perfused catheters. Recent studies have shown that for correct IAP measurement with traditional AFC, the bladder needs to be primed with 25 mL of saline solution to allow pressure wave transmission to the transducer outside of the body, which limits continuous IAP monitoring. Methods: In this study, a novel triple balloon, air-filled TraumaGuard (TG) catheter system from Sentinel Medical Technologies (Jacksonville, FL, USA) with a unique balloon-in-balloon design was evaluated in a porcine and cadaver model of IAH via laparoscopy (IAPgold). Results: In total, 27 and 86 paired IAP measurements were performed in two pigs and one human cadaver, respectively. The mean IAPTG was 20.7 ± 10.7 mmHg compared to IAPgold of 20.3 ± 10.3 mmHg in the porcine study. In the cadaver investigation, the mean IAPTG was 15.6 ± 10.8 mmHg compared to IAPgold of 14.4 ± 10.4 mmHg. The correlation, concordance, bias, precision, limits of agreement, and percentage error were all in accordance with the WSACS (Abdominal Compartment Society) recommendations and guidelines for research. Conclusions: These findings support the use of the TG catheter for continuous IAP monitoring, providing early detection of elevated IAP, thus enabling the potential for prevention of IAH and ACS. Confirmation studies with the TraumaGuard system in critically ill patients are warranted to further validate these findings.

Comparison of water and air charged transducer catheter pressures in the evaluation of cystometrogram and voiding pressure studies.

AIMS: Air-charged (AC) and water-perfused (WP) catheters have been evaluated for differences in measuring pressures for voiding dysfunction. Typically, a two-catheter system was used. We believe that simultaneous pressure measurements with AC and WP in a single catheter will provide analogous pressures for coughs, Valsalvas, and maximum pressures in voiding pressure studies (VPS). METHODS: This IRB approved prospective study included 50 women over age 21. AC dual TDOC catheters were utilized. The water-filling channel served as the bladder filler and the water pressure readings. Patients were evaluated with empty bladders and at volumes of 50-100 mL, 200 mL, and maximum capacity with cough and Valsalva maneuvers. Comparative analysis was performed on maximum stress peak pressures. At maximum bladder capacity, VPS was done and maximum voiding pressure was recorded. RESULTS: Comparing coughs and Valsalva maneuvers pressures, there was significant increase in variability between AC and WP measurements with less than 50 mL volume (P < 0.001). Significant correlations were observed between AC and WP measurements for coughs and Valsalvas with bladder volume over 50 mL. Visual impression showed virtually identical tracings. Cough measurements had an average difference of 0.25 cmH2 O (±8.81) and Valsalva measurements had an average difference of 3.15 cmH2 O (±4.72). Thirty-eight women had usable maximum voiding pressure measurements and had a strong correlation. CONCLUSIONS: Cystometrogram and maximum voiding pressure measurements done with either water or air charged catheters will yield similarly accurate results and are comparable. Results suggest more variability at low bladder volumes <50 mL.

Laparoscopically-treated ovarian torsion in a 32-week pregnancy: A case report.

Ovarian torsion is a gynecologic emergency which, while rare during pregnancy, is associated with increased risk during pregnancy. Most torsions during pregnancy occur during the first and second trimester, with only 10.5% of cases reported during the third trimester. A 35-year-old woman at 32 weeks and 2 days of gestation presented with right lower quadrant abdominal pain. Transvaginal ultrasound demonstrated a large right ovarian cyst and decreased flow on color Doppler consistent with ovarian torsion. The diagnosis was confirmed via diagnostic laparoscopy with direct visualization of the necrotic, edematous ovarian cyst and pedicle, which had been torsed twice. The pedicle was detorsed and the necrotic cyst was resected while sparing as much of the normal ovary as possible. The patient provided written consent for publication of this case report. Data supports that laparoscopy is a safe and reasonable treatment for ovarian torsion during pregnancy. It is associated with shorter hospital stays and fewer postoperative complications without increasing the risk of obstetric or neonatal complications. Much of this data, however, is obtained from case reports of torsions during the first and second trimester. The incidence of third trimester ovarian torsion is estimated to be 5-10% of torsion cases that occur in pregnancy. This case demonstrates a successful laparoscopic treatment of a third-trimester torsion in a woman who went on to deliver a healthy baby girl by spontaneous vaginal delivery.

A Rare Culprit of Simultaneous Arteriovenous Thromboembolism: Acute Viral Perimyocarditis.

Simultaneous arteriovenous embolism is extremely rare. Herein, we present a rare case of systemic arteriovenous emboli in a healthy 33-year-old male after an episode of acute viral perimyocarditis. The culprits are postulated to be viral-induced myocardial necrosis and resulting proinflammatory state in the setting of negative malignant, autoimmune, genetics, and chronic infectious conditions. The patient was successfully managed with guideline-directed medical therapy and safely discharged to a subacute rehabilitation facility.