Can uterine artery embolization be an alternative to plastic and reconstructive uterus operation by minimally invasive surgery?

Introduction: Plastic and reconstructive minimally invasive surgery has been established as gold standard in myomectomy. Therapy failure eventually leads to future surgical interventions or hysterectomy: surgeons and patients should be aware of the risks and benefits. We conducted a systematic review to analyse the evidence on the therapeutic indications and adverse events associated with uterine artery embolization and thereby evaluating if this method could be a valid alternative therapy. Methods: In concordance with PRISMA guidelines, literature research was made in PubMed, Cochrane Library, UpToDate, Amboss and Medline databases. Clinical trials, reviews and case reports published in English between January 2010 and June 2020 were included. Results: 44 articles were included out of 838 papers identified at initial search. Regarding uterine fibroids, three original papers and one Cochrane review reported the benefits of the procedure as an alternative to surgery, even in large and giant fibroids. Furthermore, several studies discussed the use of embolization for postpartum haemorrhage to decrease rates of hysterectomy after other haemostatic methods were exhausted, because of the potential risk of abnormal placentation in a future pregnancy. The procedure can also be successfully used as prophylactic method in different obstetrical procedures. Conclusions: The use of embolization in different uterine pathologies is a minimally invasive procedure as an alternative to surgery, especially in women who desire to preserve their uterus. Its related complications are described and can be avoided by a stringent indication of the procedure. More evidence regarding fertility after UAE, use of the procedure prophylactically in obstetrical haemorrhage or in adenomyosis is needed.

Quantification of bleeding during dental extraction in patients on dual antiplatelet therapy.

In spite of the possibility of triggering thromboembolic events, many professionals indicate the suspension of antiplatelet agents before dental surgical procedures. The aim of this study was to perform a quantitative assessment of intraoperative bleeding in patients on dual antiplatelet therapy. A case-control study was conducted in patients on dual antiplatelet therapy (APT group) and in patients who did not use these medications (control group). The following examinations were requested: complete blood cell count, blood coagulation tests, and platelet aggregation. The quantity of bleeding was measured intraoperatively by collection of aspirated blood. The mean volume of blood lost during the surgical procedure was 6.10ml in the control group and 16.07ml in the APT group (P=0.002). The mean volume of blood lost per minute was 0.60ml/min in the control group and 1ml/min in the APT group (P=0.001), with local haemostatic methods being sufficient to control the bleeding. There was no postoperative bleeding complication in any case. Patients on dual antiplatelet therapy presented a larger volume of bleeding, but this could be controlled by means of local haemostatic measures. Therefore, there is no need to stop either of the two dual antiplatelet therapy medications before dental extractions.

A haemostatic technique using silicone gel dressing for burn surgery.

Significant blood loss and high rates of transfusion remain ongoing concerns in burn surgery. We have reported a haemostatic technique using silicone gel dressing to minimise bleeding during tangential excision in burn surgery. The purpose of this study was to identify the efficacy of our novel haemostatic technique for burn surgery. This study was a retrospective observational study. From 1 April 2011 to 31 March 2015, we collated data including pre- and 24-hour postoperative haemoglobin levels from patients over 15 years of age who underwent tangential excision for burn injuries. We also collected data on the amounts of measured blood loss, blood transfusions, excised areas, harvest areas and duration of surgeries. The collected data were divided into a conventional group and a silicone gel dressing group. Then, we analysed the differences between the two groups. During the study period, 357 patients were admitted to our burn centre, and 60 operations (44 patients) were performed by tangential excision. The conventional group comprised 28 operations (20 patients), and the silicone gel dressing group comprised 32 operations (26 patients). Excised areas and harvested areas were significantly larger in the silicone gel dressing group than in the conventional group. The amount of blood loss per percent excised and the number of units of blood transfused were significantly lower in the silicone gel dressing group. Duration of the surgeries was almost the same between the two groups. Application of our new technique during tangential excision for burn injuries resulted in a remarkable reduction in blood loss and transfusion requirements.

A rare complication of Epistats.

We report a 53-year-old man who sustained severe facial and base of skull fractures. At the scene of his accident he had Epistats (Medtronic Sofamor Danek, Memphis, TN, USA) placed for control of his severe nasal haemorrhage, subsequently resulting in the migration of one Epistat into the anterior cranial fossa. There are numerous reports of inadvertent intracranial placement of medical equipment, predominantly in association with complex facial and skull trauma. Other factors that can predispose to aberrant location include previous anterior cranial base surgery and lesions affecting structures in that area.

Diseño de un medio de enseñanza, para el estudio de técnicas hemostáticas en sangramientos postonsilectomía / Design of a Teaching Aid in the Study of the Hemostatic Techniques in Post-tonsillectomy Bleeding

Se confeccionó un medio de enseñanza por tres especialistas de Otorrinolaringología del Hospital Pediátrico Provincial Docente "Pepe Portilla" de Pinar del Río en el año 2006. Se lograron mostrar, mediante el uso de esta maqueta, las diferentes estructuras anatómicas de la orofaringe y la conducta a seguir ante el sangramiento en pacientes amigdalectomizados. Se utilizaron materiales desechables y de bajo costo para su diseño. Se obtuvo el 100 % de promoción en los estudiantes de la brigada # 88 con el aprendizaje de la anatomía orofaríngea y el dominio de las técnicas para hacer hemostasia en el sangramiento de pacientes tonsilectomizados.

Three otolaryngologists designed a teaching aid at "Pepe Portilla" Provincial Children Teaching Hospital in Pinar del Rio in 2006. It was shown by means of this model the different anatomical structures of the oro-pharynx and the behavior to be followed in presence of a bleeding in patients underwent a tonsillectomy. Disposal and low cost materials were used for the design . A promotion of 100 percent was attained in students from the Brigade 88 knowing the oropharyngeal anatomy as well as the techniques for the hemostasis in presence of bleeding in patients undergone a tonsillectomy.