Thoracic paravertebral nerve block combined with acupuncture for the treatment of postherpetic neuralgia in the chest and abdomen: A prospective randomized controlled trial.

BACKGROUND: Postherpetic neuralgia (PHN) is the most common complication of varicella-zoster infection and tends to occur in older people. All patients treated with a single regimen have not achieved consistent success across all current study protocols, and multimodal combination regimens still need to be explored. METHODS: A total of 111 patients with PHN were randomly divided into drug group (group A), thoracic paravertebral nerve block group (group B), thoracic paravertebral nerve block combined with acupuncture group (group C), with 37 cases in each group. Group A: received oral gabapentin capsules and external lidocaine gel plaster; group B: combined with thoracic paravertebral nerve block based on group A; group C: combined with acupuncture based on group B. The primary outcome was effective rate, and secondary outcomes included pain sensation score (numerical rating scale), SF-36 quality of life score, and sleep quality. RESULTS: Before treatment, there were no significant differences in numerical rating scale value, SF-36 quality of life score, and sleep quality level among the 3 groups (P > .05). After 12 weeks of treatment, the total effective rate of treatment of patients in group C (91.43%) was higher than that in group B (77.14%), and significantly higher than that in group A (51.43%) (P < .05). CONCLUSION: Based on drug treatment combined with thoracic paravertebral nerve block and acupuncture, the treatment of PHN in the elderly can quickly and effectively relieve pain, improve the quality of life of patients, and improve the quality of sleep.

[Common and New Regional Anaesthesia Techniques Under Review - From Head to Abdomen]. / Alte und neue Regionalanästhesieverfahren unter Review ­ Kopf bis Bauch.

By implementation of sonography regional anesthesia became more relevant in the daily practice of anesthesia and pain therapy. Due to visualized needle guidance ultrasound supports more safety during needle placement. Thereby new truncal blocks got enabled. Next to the blocking of specific nerve structures, plane blocks got established which can also be described as interfascial compartment blocks. The present review illustrates published and established blocks in daily practice concerning indications and the procedural issues. Moreover, the authors explain potential risks, complications and dosing of local anesthetics.

Effect of verbal instructions on trunk muscle activity during volitional preemptive abdominal contraction.

OBJECTIVE: This study investigated the effect of Verbal Instruction (VI) strategies on trunk muscle contraction among healthy subjects. The effect of three VI Abdominal Drawing-In Maneuver (ADIM) and two VI Abdominal Bracing Maneuver (ABM) strategies on left Internal (LIO) and External Oblique (LEO) and bilateral superficial Multifidi (sMf) activation was examined. DESIGN: Within-subjects, repeated measure design. METHODS: Surface EMG (sEMG) measured LIO, LEO, and sMf activity in 28 subjects (mean age 23.5 ± 5.5 years). Testing included five supine hook-lying and five quiet standing conditions. RESULTS: One-way ANOVAs demonstrated no significant main effect for ADIM or ABM in supine or standing (p > .05). Muscle activation amplitudes during VPAC conditions demonstrated higher mean values for standing versus supine (p < .05) except for two conditions involving LEO. Friedman Tests for dominant strategy demonstrated a significant main effect for ADIM-VI and ABM-VI strategies. Post-hoc testing generally showed the dominant strategy to be significantly higher versus others. CONCLUSION: No single preferred VI cue for ADIM or ABM was observed. Each subject's dominant strategy dictated the most suitable VI. Standing was preferred for LIO and sMf activation, whereas position did not change LEO activation. Non-significant correlations between all muscle pairings during all ADIM and ABM strategies were observed. These findings may suggest the need for healthcare providers who understand the intricacies of trunk stability to teach and monitor VPAC with either ADIM or ABM options.

Oncological outcomes and hospitalization cost of hyperthermic intraperitoneal chemotherapy (HIPEC) open and closed abdomen techniques: Results from two French expert centers.

BACKGROUND: Hyperthermic intraperitoneal chemotherapy (HIPEC) associated with CC0 excision is performed using either an open (OPEN_HIPEC) or closed abdominal technique (CLOSED_HIPEC). However, little data is available on the costs of this treatment, as there is no code for HIPEC in the French Classification of Medical Acts. Oncological outcomes and the mean cost of hospitalization were compared. METHODS: Between 2017 and 2021, 144 patients with peritoneal carcinomatosis (all etiologies) were included (OPEN_HIPEC, n = 70; CLOSED_HIPEC, n = 74) in this retrospective two-center study. Morbi-mortality, overall survival (OS), recurrence-free-survival (RFS) and mean cost of hospitalization were compared. RESULTS: The median OS and RFS were 71.3 months [63-71.5] and 26.8 months [20-35.3] respectively, and were similar for both techniques; and after stratification by histology. Multivariate analysis adjusted on PCI score of OS identified mitomycin as a protective factor (HR = 0.31 [0.10-0.90], p = 0.032) and ASA score>2 (HR = 2.32 [1.32- 4.06], p = 0.003) and number of resection (HR = 1.21 [1.06-1.39], p = 0.006) as a risk factors of RFS. Complication rates at day 30 were similar between OPEN and CLOSED_HIPEC, 31 (44.3 %) vs 42 (56.8 %); p = 0.135. OPEN_HIPEC had more severe complications (11 (35.5 %) vs 6 (14.3 %); p = 0.034). The mean cost of hospitalization was estimated as €15,627 for OPEN_HIPEC and €14,211 for CLOSED_HIPEC for a mean length-of-stay of 12.7 and 16.7 days respectively. The mean amount received by the hospital per hospitalization was estimated at €16,399 and €15,536 respectively. CONCLUSIONS: OS and RFS were similar for open and closed HIPEC. Severe complications at day 30 were more frequent in OPEN_HIPEC group. The amount received by hospital for both HIPEC techniques is sufficient.

Effects of electroacupuncture on obesity: A systematic review and meta-analysis.

BACKGROUND: This systematic review and meta-analysis evaluated the efficacy of electroacupuncture for the treatment of obesity. METHODS: We searched 8 electronic databases for articles published between 2005 and 2021, including only randomized controlled trials (RCTs) in the review. The intervention groups received either electroacupuncture alone or electroacupuncture with standard care, whereas the control groups received sham electroacupuncture, standard care, or no treatment. The primary outcome was the body mass index (BMI), and the secondary outcomes were the body weight (BW), waist circumference (WC), hip circumference, waist-to-hip ratio (WHR), body fat mass, body fat percentage, and adverse effects. Continuous outcome data are presented as mean differences (MDs) with 95% confidence intervals (CIs). RESULTS: This systematic review and meta-analysis included 13 RCTs involving 779 participants. Results revealed that the BMI (MD: -0.98; 95% CI: -1.35 to -0.61), BW (MD: -1.89; 95% CI: -2.97 to -0.80), WC (MD: -2.67; 95% CI: -4.52 to -0.82), and WHR (MD: -0.03; 95% CI: -0.06 to -0.01) were significantly improved in the intervention groups compared with those in the control groups. Adverse effects were reported in 5 studies. The most commonly used acupoint in the abdomen was ST25, whereas the most commonly used acupoints in other regions were ST36 and SP6 for the treatment of obesity. ST25 was the most commonly used acupoint connected by electroacupuncture. CONCLUSION: This systematic review and meta-analysis suggested that electroacupuncture is an effective and safe therapy for simple obesity. To increase the reliability of this study, further detailed, long-term studies should be conducted on the effects of electroacupuncture on obesity.

Acupuncture as a Therapeutic Intervention for Acute Gastrointestinal Injury (AGI): A Preliminary Study.

Acute gastrointestinal injury (AGI) is a significant factor contributing to increased mortality in patients receiving intensive care unit (ICU) care. Traditional Chinese medicine's acupuncture techniques offer an alternative approach to treating digestive disorders by controlling gastrointestinal secretion, improving gastrointestinal motility, and minimizing side effects. Transabdominal intestinal ultrasonography has proven effective in assessing gastrointestinal injury in critically ill patients. This study aims to evaluate the therapeutic effect of acupuncture in AGI patients using ultrasound. The main steps of the study include the syndrome-based selection of appropriate acupuncture points, including Hegu (LI4), Zhongwan (CV 12), Tianshu (ST 25), Zusanli (ST 36), Shangjuxu (ST 37), and Xiajuxu (ST 39), followed by a 30 min Deqi acupuncture session once a day for 1 week. The treatment's effectiveness is assessed by an experienced physician using abdominal gastrointestinal ultrasonography. This article provides a detailed account of how to standardize the use of acupuncture in treating gastrointestinal dysfunction in critically ill patients.

Negative-Pressure Wound Therapy for Open Abdomen in Surgical Reintervention after Curative Surgery of Peritoneal Malignancy Increases the Risk of Recurrence.

OBJECTIVE: Negative-pressure wound therapy for open abdomen (NPWTOA) helps reduce the risk of abdominal compartment syndrome. However, the risk of recurrence of cancer is unclear when NPWTOA is applied after oncologic resection. The aim of this study was to evaluate the effects of NPWTOA used for major complications on patients treated with cytoreductive surgery for peritoneal malignancy (PM). METHODS: All patients who underwent an NPWTOA after potentially curative surgery of PM in a single institution were included. These patients were pair matched 1:3 on the Peritoneal Cancer Index, completeness of cytoreduction using a scoring index, and PM origin with patients who underwent surgical reintervention without NPWTOA after curative surgery of PM. Survival among the two groups was compared using the Kaplan-Meier method. RESULTS: Between 2011 and 2017, among 719 curative surgeries for PM, 13 patients underwent an NPWTOA after surgical reintervention. Researchers paired 9 of these patients to 27 others without NPWTOA after surgical reintervention. Median overall survival was 4.8 and 35 months (P = .391), and median disease-free survival was 4.0 and 13.9 months (P = .022) for the NPWTOA and non-NPWTOA groups, respectively. CONCLUSIONS: The use of the NPWTOA during surgical reintervention after curative surgery for PM may increase the risk of early recurrence.

Intraoperative Epidural Analgesia Practices And Their Outcomes In Major Abdominal Surgeries At A Tertiary Care Hospital In Karachi.

OBJECTIVE: To investigate the association involving site, concentrations and dosing of local anaesthetics used intraoperatively on postoperative pain scores, motor block and need for rescue analgesia. METHODS: The observational study was conducted from June 1, 2020, to May 31, 2021, at the Aga Khan University Hospital, Karachi, and comprised patients planned for major abdominal surgeries with epidurals as primary analgesic modality. They were followed prospectively from placement of epidurals to 24h postoperatively. Data was collected from anaesthesia chart and pain management notes. Data was analysed using SPSS 19. RESULTS: Of the 170 patients, 96(56.4%) were females and 74(43.5%) were males. The overall mean age was 54.1±12.6 years and mean body mass index was 26.7±5.5Kg/m2. More than half of the patients 110(64.7%) had thoracic epidural, while 60(35.3%) had lumber epidural. Requirement of opioid co-analgesia intraoperatively was significantly high with higher compared to lower concentration of local anaesthetics (p=0.004). The difference in frequencies of motor block was significantly associated with catheter length (p=0.006). CONCLUSIONS: Intraoperative management of epidurals is an essential but overlooked component of perioperative pain management. Guidelines should be formulated for intraoperative epidural analgesic regimens to improve postoperative outcomes.

The results of designing a new prototype device and algorithm in closed method intraperitoneal hyperthermia model in rats.

BACKGROUND: There is currently no standard medical device and method available for hyperthermic intraperitoneal therapy studies in rats. In this study, we present our designed device and algorithm that operates based on our own protocol for hyperthermic intraperitoneal treatment in rats. The aim was to demonstrate the effectiveness of the designed device, algorithm, and hyperthermia protocol by showing that the device can achieve the desired temperature inside the rat's abdomen, does not cause rat loss due to complications, operates autonomously, and provides warnings to the operator in case of emergencies. METHODS: A closed method for intraperitoneal hyperthermia protocol was established for 6 female 8-week-old (280-310 g) albino Wistar rats. Fluid inlet and outlet tubes and a temperature probe were inserted through a 1 cm vertical incision between the xiphoid and bladder in the rat's abdomen, and the skin was sutured in a circular manner. A protocol for intraperitoneal hyperthermic treat-ment was established using a saline solution at a flow rate of 100 mL/min for 60 min, maintaining a temperature of 41°C±0.5 inside the rat's abdomen. RESULTS: During the study, a temperature of 41°C±0.5 was successfully achieved in the abdomen of all rats at a flow rate of 100 mL/min±5 for 60 min. Due to three rats reaching a rectal temperature above 38.5°C during the hyperthermia protocol, external cooling was applied to the rat's tail base using ice. There were no losses until the postoperative 72nd h, and the study was successfully completed. CONCLUSION: Our designed device and algorithm, which prioritize animal welfare, operate rapidly, safely, and with high accuracy sensitivity, have been successful in hyperthermic intraperitoneal treatment studies in rats. We believe that they can be used as a stan-dard method and approach in hyperthermic intraperitoneal studies in rats.

EFFECTIVENESS OF PERINEAL PELVIS REHABILITATION COMBINED WITH BIOFEEDBACK AND RADIOFREQUENCY DIATHERMY (RDF) IN ANORECTAL FUNCTIONAL PAIN SYNDROMES ASSOCIATED WITH PARADOXICAL CONTRACTION OF THE LEVATOR ANI MUSCLES. A PROSPECTIVE STUDY.

•Anorectal functional pain syndrome is a very often disabling disease with a consequent significant negative impact on the patient's quality of life. Chronic proctalgia, in many patients, is secondary to the paradoxical contraction of the pelvic floor and associated with a dissynergy between the thorax-abdomen and the pelvic floor. •The use of radiofrequency diathermy with a system of static electrodes associated with biofeedback represents a valid rehabilitation option for those patients suffering from anorectal functional pain syndrome because it reduces pain and paradoxical contraction of the levator ani and improves quality of life of the patient. Background - Anorectal functional pain syndrome, also called chronic proctalgia, represents a neglected clinical entity and often confused with other syndromes such as vulvodynia or acute proctalgia. It is a very often disabling disease with a consequent significant negative impact on the patient's quality of life. Chronic proctalgia, in many patients, is secondary to the paradoxical contraction of the pelvic floor and associated with a dissynergy between the thorax-abdomen and the pelvic floor. To improve symptoms in functional anorectal pain syndromes, various rehabilitation techniques are used with the aim of promoting relaxation of the pelvic floor; however, to improve defecatory dynamics in patients with levator ani syndrome, only biofeedback has shown efficacy in a randomized study. The aim of this work is to evaluate whether a rehabilitation protocol with manometric biofeedback and radiofrequency diathermy (mt100 Fremslife emotion Tecar) reduces pain and paradoxical contraction of the levator ani and improves the quality of life in patients with anorectal pain syndromes. functional. Methods - This was a prospective study on 30 patients (20 women and 10 men) with anorectal functional pain syndrome and paradoxical contraction of the pelvic floor enrolled at the UOC of General, Minimally Invasive, Oncological and Obesity Surgery of the AOU "Luigi Vanvitelli" of Naples, Italy, from September 2021 to May 2022. All patients were evaluated with a coloproctological specialist visit followed by anorectal manometry and evaluation of altered clinical physiatric parameters (Brusciano Score). The protocol consisted of 10 rehabilitation sessions of the pelvic floor once a week and lasting approximately 45 minutes. During the sessions the patients were subjected to diathermy / radiofrequency treatment (10 minutes) with a static resistive electrode on the diaphragm, during which they were required to breathe diaphragmatically and to become aware of the perineal muscles, under the supervision of a physiotherapist; followed by application of diathermy with static capacitive (5 minutes) and resistive (10 minutes) electrode at the lumbar level. This was followed by the use of manometric biofeedback (15 minutes of tonic / phasic exercises) in order to instruct the patient on the reflex mechanism to obtain a voluntary relaxation of the external anal sphincter. The variables evaluated were Pain (VAS 0-10) and the questionnaire on the impact of colorectal and anal pathologies on the quality of life (CRAIQ-7) at the beginning, after 3 months and at the end of the treatment. Results - After 10 weeks, the rehabilitation treatment combined with diathermy and manometric biofeedback proved effective in the short term with a reduction in the scores of the Vas scale and CRAIQ-7 questionnaire and an increase in the percentage of release of the anal muscles on anorectal manometry. Conclusion - The use of radiofrequency diathermy with a system of static electrodes associated with biofeedback represents a valid rehabilitation option for those patients suffering from anorectal functional pain syndrome because it reduces pain and paradoxical contraction of the levator ani and improves quality of life of the patient.

Novel laser hair removal in all skin types.

BACKGROUND: Laser has been long accepted as a solution for excess or unwanted hair growth yet traditional lasers are not always ideal for safe and effective outcome for all skin types and hair characteristics. A diode laser module combining three wavelengths (755, 810, and 1064 nm) in a single pulse was developed to provide a fast and long-term solution for subjects with various profiles. AIMS: To evaluate the safety and efficacy of a Triple wavelength diode laser module for hair removal treatment in all skin types (Fitzpatrick I-VI). SUBJECTS AND METHODS: This was a prospective, dual centered, single-arm study. Subjects were treated with a novel diode laser module. Thirty-six subjects were enrolled, sixteen with Fitzpatrick skin types I-IV (46%) and twenty with Fitzpatrick skin types V-VI (54%). Treatment areas were axilla and bikini lines. Subjects underwent 4 treatment sessions at 6 weeks ± 5 days intervals and attended a follow-up visit 3 months after the last treatment session. 2D digital photographs were taken at baseline and at the follow-up visit, and a hair count was conducted by three blinded evaluators. RESULTS: A significant reduction in hair count between baseline and the 3-month follow-up visit was observed in both axilla and bikini lines for all skin types. The mean hair reduction was 41.5 ± 19.4% and 48.1 ± 20.9% in the axilla and bikini line, respectively. A significant hair reduction was also observed within skin type groups; mean hair reduction 45.5 ± 16.9% and 40.3 ± 17.2% in skin types I-IV and V-VI, respectively, indicating similar efficacy for both light and dark skin types. No serious adverse events were reported. CONCLUSIONS: This study demonstrates that the Soprano Titanium laser platform is safe and effective for hair removal treatment in all skin types.

Spatial resolution, noise properties, and detectability index of a deep learning reconstruction algorithm for dual-energy CT of the abdomen.

BACKGROUND: Iterative reconstruction (IR) has increasingly replaced traditional reconstruction methods in computed tomography (CT). The next paradigm shift in image reconstruction is likely to come from artificial intelligence, with deep learning reconstruction (DLR) solutions already entering the clinic. An enduring disadvantage to IR has been a change in noise texture, which can affect diagnostic confidence. DLR has demonstrated the potential to overcome this issue and has recently become available for dual-energy CT. PURPOSE: To evaluate the spatial resolution, noise properties, and detectability index of a commercially available DLR algorithm for dual-energy CT of the abdomen and compare it to single-energy (SE) CT. METHODS: An oval 25 cm x 35 cm custom-made phantom was scanned on a GE Revolution CT scanner (GE Healthcare, Waukesha, WI) at two dose levels (13 and 5 mGy) and two iodine concentrations (8 and 2 mg/mL), using three typical abdominal scan protocols: dual-energy (DE), SE 80 kV (SE-80 kV) and SE 120 kV (SE-120 kV). Reconstructions were performed with three strengths of IR (ASiR-V: AR0%, AR50%, AR100%) and three strengths of DLR (TrueFidelity: low, medium, high). The DE acquisitions were reconstructed as mono-energetic images between 40 and 80 keV. The noise power spectrum (NPS), task transfer function (TTF), and detectability index (d') were determined for the reconstructions following the recommendations of AAPM Task Group 233. RESULTS: Noise magnitude reductions (relative to AR0%) for the SE protocols were on average (-29%, -21%) for (AR50%, TF-M), while for DE-70 keV were (-28%, -43%). There was less reduction in mean frequency (fav ) for DLR than for IR, with similar results for SE and DE imaging. There was, however, a substantial change in the NPS shape when using DE with DLR, quantifiable by a marked reduction in the peak frequency (fpeak ) that was absent in SE mode. All protocols and reconstructions (including AR0%) exhibited slight to moderate shifts towards lower spatial frequencies at the lower dose (<12% in fav ). Spatial resolution was consistently superior for DLR compared to IR for SE but not for DE. All protocols and reconstructions (including AR0%) showed decreased resolution with reduced dose and iodine concentration, with less decrease for DLR compared to IR. DLR displayed a higher d' than IR. The effect of energy was large: d' increased with lower keV, and SE-80 kV had higher d' than SE-120 kV. Using DE with DLR could provide higher d' than SE-80 kV at the higher dose but not at lower dose. CONCLUSIONS: DE imaging with DLR maintained spatial resolution and reduced noise magnitude while displaying less change in noise texture than IR. The d' was also higher with DLR than IR, suggesting superiority in detectability of iodinated contrast. Despite these trends being consistent with those previously established for SE imaging, there were some noteworthy differences. For DE imaging there was no improvement in resolution compared to IR and a change in noise texture. DE imaging with low keV and DLR had superior detectability to SE DLR at the high dose but was not better than SE-80 kV at low dose.

The effect of aroma massage on constipation in elderly individuals.

BACKGROUND: Constipation is a health problem commonly seen in the elderly individuals. Abdominal massage is thought to stimulate the rectal loading by increasing intra-abdominal pressure. PURPOSE: To determine effects of aromatherapy massage on constipation in the elderly individuals. METHODS: Forty eight elderly individuals with constipation were randomized to aromatherapy massage, and control groups. Massage was applied with oil blend to the experimental group during 3 weeks, once a day and lasting 15 min. RESULTS: During aroma massage and after aroma massage in intervention group, mean scores related to 'defecation number', 'amount of feces' and 'consistency of feces' were increased and these increases were statistically significant. The mean scores related to 'straining during defecation' and 'feeling of incomplete discharge of feces' were decreased. CONCLUSION: It was determined that aroma massage practice has increased 'frequency of defecation', 'amount of feces' and 'consistency of feces' but decreased the 'straining during defecation' and 'feeling of incomplete discharge of feces'.

Continuous manual agitation significantly improves temperature distribution during closed hyperthermic intraperitoneal chemotherapy: Results of a porcine model.

BACKGROUND: Debate persists regarding the need for shaking during hyperthermic intraperitoneal chemotherapy. Studies assessing the thermal behaviors of the perfusate throughout the abdomen during hyperthermic intraperitoneal chemotherapy are limited. METHODS: A closed hyperthermic intraperitoneal chemotherapy technique was performed in an institutional International Animal Care and Use Committee approved porcine model targeting a 41°C outflow temperature. Continuous temperature monitoring was conducted. Abdominal shaking was performed for 60 second intervals and temperatures were allowed to equilibrate without shaking between intervals. Temperature distributions and changes due to shaking were evaluated. These findings were validated against human subjects' data. RESULTS: The experimental procedure was conducted in 2 different animals and with 6 total shaking intervals assessed. Without shaking, temperatures were highly variable ranging between 38.0 to 42.2°C. Shaking the abdomen reduced the mean range of temperatures across all locations observed from 3.9°C to 0.8°C (P < .01). The locations of the most divergent temperatures varied based on perfusion cannula position. The point of minimum temperature heterogeneity was achieved in 28.3 (19.1-37.5) seconds. After shaking stopped, heterogeneity equal to the baseline measurements was seen on average within 25.7 (13.3-38.0) seconds. The outflow catheter differed from the system mean temperature by 1.4°C and from the coldest-reading probe by 2.8°C and outperformed the inflow catheter for all time points. With shaking these were significantly reduced to 0.4°C (P < .01) and 0.6°C (P < .01). The patient data mirrored that of the pig data. CONCLUSION: Shaking significantly reduces temperature variability within the abdomen during hyperthermic intraperitoneal chemotherapy, and significantly improves the ability of the outflow catheter to estimate internal temperatures.

Replacement Adaptor 09106 for patients with a dynamic graciloplasty or patients with sacral neuromodulation and abdominal implantable pulse generators: a retrospective, single centre, Stage 2a/2b development IDEAL case series.

AIM: Due to the introduction of a new implantable pulse generator (IPG), the Interstim II, patients with either a dynamic graciloplasty or an abdominally placed IPG for sacral neuromodulation could not undergo surgery to replace their IPG in the case of end of battery life. For these patients, the Medtronic Replacement Adaptor 09106 was created. This retrospective case series aims to study safety and feasibility of the Medtronic Replacement Adaptor 09106 in patients with abdominally placed IPGs. METHODS: Seventeen patients (11 women, six men) received a replacement adaptor with a follow-up of 6 months. Outcome measures consisted of a bowel habit diary. Adverse events were classified using the Clavien-Dindo classification. RESULTS: Outcome measures in the bowel habit diaries after replacement (feasibility) did not differ significantly from outcome measures before replacement. Adverse events occurred in four out of 17 patients (24%): two patients initially showed pocket site pain (Clavien-Dindo Grade I), which resolved without intervention. One patient suffered from poor wound closure (Clavien-Dindo Grade II) and one patient had persisting pocket pain (Clavien-Dindo Grade IIIa) for which a pocket revision was performed. Statistical analyses were performed making paired comparisons using a Wilcoxon signed rank test. CONCLUSION: The Medtronic Replacement Adaptor 09106 is a valuable option for patients with dynamic graciloplasty or sacral neuromodulation and abdominal IPG and has complication rates similar to replacement of the Interstim without Replacement Adaptor 09106.

Intravascular papillary endothelial hyperplasia of the spleen in a child: a case report.

BACKGROUND: Intravascular papillary endothelial hyperplasia (IPEH) is a vascular tumor characterized by the proliferation of endothelial cells with papillary formation. It is a rare benign condition affecting the head and neck. Currently, no cases of IPEH of the spleen have been reported. Here, we report a case of IPEH of the spleen in a child and discuss its clinical manifestations, imaging features, and surgical treatment. CASE PRESENTATION: A 5-year-old female presented with a 4-month-old tumor in the left upper abdomen, abdominal pain, and constipation. She underwent radiography, barium enema, US, and MRI. A solid space-occupying mass was found in the left abdominal cavity on preoperative imaging, and it was diagnosed as angiosarcoma. The lesion was surgically resected. Histopathological analysis was consistent with IPEH. CONCLUSION: Clinicians should consider the possibility of IPEH in patients presenting with tumors in the spleen, which is curable by surgical resection. Malignant vascular tumors must be excluded in the differential diagnosis of IPEH to prevent misdiagnosis and inappropriate overtreatment.