Winograd Wedge Resection Matrixectomy versus Partial Nail Avulsion with Chemical Cautery: A Tertiary Institution's Clinical Outcomes and Proposed Triaging Protocol.

BACKGROUND: Onychocryptosis, or ingrown toenail, is a common condition affecting patients of varying age groups, although usually, younger patients are affected. METHODS: We compared two techniques used in our institution: Winograd wedge resection with matrixectomy (WG-M) versus partial nail avulsion with phenolization of the nail matrix (PNA-P). RESULTS: Primary outcomes of interest were presence of nail regrowth and patient satisfaction postoperatively. Secondary outcomes were postoperative pain (within the first 2 weeks and after 2 weeks), postoperative inflammation, and healing time. A total of 65 patients were included in this study: 44 patients (19 female and 25 male patients), with a mean age of 45.7 years (range, 16-83 years) underwent WG-M in the orthopedic surgery department, whereas a total of 21 patients (10 female and 11 male patients), with a mean age of 44.5 years (range, 13 to 75 years) underwent PNA-P in the podiatry department. In patients who underwent WG-M, there was one case of regrowth (2.3%) compared with no regrowth cases (0%) in the PNA-P group. There was no significant difference in regrowth rate between the two procedures (P = .494). The satisfaction rate was high for both procedures: 100% patients in the WG-M group rated themselves better than before surgery, compared with 95.7% in the PNA-P group. CONCLUSIONS: From our study, we conclude that both techniques (WG-M and PNA-P) are able to achieve similar clinical outcomes, with the PNA-P procedure being less invasive and less resource intensive, and also achieving a shorter healing time.

Managing recurrent nosebleeds in children: a retrospective review of 718 children attending a nurse-led epistaxis clinic.

OBJECTIVE: This review assessed the effectiveness of the nurse-led children's epistaxis clinic in streamlining patient care and avoiding unnecessary general anaesthesia. METHODS: A retrospective case note review was conducted of children attending the nurse-led epistaxis clinic between 2019 and 2021. RESULTS: A total of 718 children were seen over three years. Twelve (1.7 per cent) had a known coagulopathy. Of the children, 590 (82 per cent) had visible vessels and 29 (4 per cent) had mucosal crusting. Silver nitrate cautery was attempted under topical anaesthesia in 481 children, with 463 (96 per cent) successful cauterisations. Fifteen (3 per cent) were cauterised under general anaesthesia. Of the children, 706 (99 per cent) were prescribed nasal antiseptic preparations; this was the sole treatment for 58 (8 per cent). Blood investigations were requested for eight children (1 per cent) and haematology referral for three (0.4 per cent). CONCLUSION: This is the largest published series of children's nosebleeds. Given the short-lived benefit from cautery, it is suggested that general anaesthesia should not be offered routinely. However, improved haematology referral criteria are required to increase underlying diagnosis.

Comparing recurrence between cautery techniques in pediatric epistaxis.

OBJECTIVE: To compare the risk of recurrent epistaxis between children treated with silver nitrate (SN) in the office or electrocautery (EC) in the operating room (OR). METHODS: Patients aged 2-18 diagnosed with epistaxis (ICD R04.0) in 2018 and treated with SN or EC were retrospectively reviewed. Epistaxis laterality, history of nasal trauma, and personal or family history of a bleeding disorder were recorded. Patients with prior cautery or epistaxis secondary to a procedure were excluded. Recurrence was defined as initial encounter after cautery with documented epistaxis. Patients were followed up into 2022 to track onset of recurrence. Time to recurrence between SN and EC was compared with hazard curves with predictors for recurrence analyzed via Cox's proportional hazard regression. RESULTS: Among 291 patients cauterized for epistaxis, 62 % (n = 181) received SN compared to 38 % (n = 110) who underwent EC. There was significantly higher risk of recurrence when treated with SN compared to EC (Hazard ratio 2.45, 95 % CI: 1.57-3.82, P < 0.0001). Median time to recurrence was not statistically different between techniques (6.39 months (SN) (IQR: 2.33, 14.82) vs. 4.11 months (EC) (IQR: 1.18, 20.86), P = 0.4154). Complication rates were low for both groups (1.16 % (SN) vs. 0 % (EC), P > 0.05). CONCLUSION: Among patients with epistaxis, risk of recurrence is significantly higher in those cauterized with SN compared to EC. Time to recurrence is not significantly different between cautery techniques.

Feasibility and safety of bipolar radiofrequency track cautery during percutaneous image-guided abdominal biopsy procedures.

PURPOSE: The purpose of this study was to assess the feasibility and safety of using a bipolar radiofrequency track cautery device during percutaneous image-guided abdominal biopsy procedures in at-risk patients. METHODS: Forty-two patients (26-79 years old; female 44%) with at least one bleeding risk factor who underwent an abdominal image-guided (CT or US) biopsy and intended bipolar radiofrequency track cautery (BRTC) were retrospectively studied. An 18G radiofrequency electrode was inserted through a 17G biopsy introducer needle immediately following coaxial 18G core biopsy, to cauterize the biopsy track using temperature control. Bleeding risk factors, technical success, and adverse events were recorded. RESULTS: BRTC was technically successful in 41/42 (98%) of procedures; in one patient, the introducer needle retracted from the liver due to respiratory motion prior to BRTC. BRTC following percutaneous biopsy was applied during 41 abdominal biopsy procedures (renal mass = 12, renal parenchyma = 10, liver mass = 9, liver parenchyma = 5, splenic mass or parenchyma = 4, gastrohepatic mass = 1). All patients had one or more of the following risk factors: high-risk organ (spleen or renal parenchyma), hypervascular mass, elevated prothrombin time, renal insufficiency, thrombocytopenia, recent anticoagulation or anticoagulation not withheld for recommended interval, cirrhosis, intraprocedural hypertension, brisk back bleeding observed from the introducer needle, or subcapsular tumor location. No severe adverse events (grade 3 or higher) occurred. Two (2/41, 5%) mild (grade 1) bleeding events did not cause symptoms or require intervention. CONCLUSION: Bipolar radiofrequency track cautery was feasible and safe during percutaneous image-guided abdominal biopsy procedures. IRB approval: MBG 2022P002277.

Risk of Monopolar Electrosurgery in Cochlear Implant Recipients is Nominal: Evidence to Guide Clinical Practice.

OBJECTIVE: Comprehensively assess the prevalence of monopolar electrosurgery-related device complications among cochlear implant (CI) recipients. STUDY DESIGN: Multifaceted retrospective review and survey. SETTING: Tertiary medical center. METHODS: Multifaceted approach including: (i) review of the current literature; (ii) historical review of institutional data from an academic, tertiary CI center; (iii) review of industry data provided by 3 Food and Drug Administration-approved CI manufacturers; and (iv) survey of high-volume CI centers. RESULTS: Literature review identified 9 human studies, detailing 84 devices with 199 episodes of device-cautery exposure. From studies reporting on patients records, no implant showed evidence of damage after exposure. One cadaveric study using dental cautery reported 1 episode of device damage. Review of institutional records did not identify any CI damage in 84 instances of exposure. Data from the 3 major implant manufacturers showed a single report of damage that could be reasonably linked to monopolar electrosurgery, out of a possible 689,426 CIs. Last, a survey of 8 high-volume CI centers did not identify any adverse events associated with monopolar cautery. CONCLUSION: These data estimate the risk of adverse device-related events or tissue injury to be extraordinarily low. Short of operating in immediate proximity to the CI (ie, the ipsilateral temporoparietal scalp), these data indicate that monopolar electrosurgery can be used in the body and the head-and-neck of CI recipients with nominal risk. These findings may guide decision-making in cases that are optimally or preferably performed with monopolar electrocautery and can be used to counsel CI patients following inadvertent exposures.

Gomco circumcision in the office in patients heavier than 5.5 Kg and/or older than 3 months.

INTRODUCTION: Although most pediatric urologists do not perform clamp circumcisions in boys older than 3 months or heavier than 5.5 kg, there are no universally accepted guidelines on the optimal patient age or weight. OBJECTIVE: To compare outcomes of office circumcision within and outside these traditional patient parameters. METHODS: This is a retrospective review of circumcisions performed by a single surgeon from 2019 to 2022. Demographics reviewed include age and weight at time of circumcision, gestational weeks at birth, as well as post-procedure: bleeding, planned and unplanned visits, adhesions/concealment, and interventions related to the circumcision. "Active Bleeding" was defined as bleeding occurring after discharge requiring intervention with pressure, sutures, or cautery. "All Bleeding" included Active Bleeding, and cases where bleeding was controlled at home with pressure, stopped by the time of arrival at clinic or emergency department, and immediate bleeding after circumcision controlled before discharge. RESULTS: During the study period, 773 Gomco circumcisions were performed. A total of 603 patients (78%) had post-procedure evaluation 2 weeks after circumcision. 574 patients (74%) were less than 5.5 kg and 199 (26%) over. Only age corrected for gestation was used in the study: 658 (85%) were younger than 3 months and 115 (15%) older. There was no significant difference in Active Bleeding based on weight (p = 0.3819) or age (p = 0.2798), and no difference in All Bleeding based on weight (p = 0.2072). There was a significant difference (p = 0.0258) in All Bleeding based on age. There was also a significant difference in unexpected visits based on weight (p = 0.0258) and age (p = 0.0131). With regards to adhesions, there was no statistical significant differences when comparing weight or age. However, older and heavier boys had significantly more concealment (5% vs <1%). DISCUSSION: Our study showed Active Bleeding rates 0.5-0.9% higher in the older and heavier group, although the difference did not reach statistical significance. We found a significantly increased rate of unexpected post-procedure visits of around 3.5-4.7% in those patients older than 3 months and heavier than 5.5 kg. Also, post -procedure concealment was significantly increased in the older and heavier boys. Modifications of the dressing for high risk groups could reduce the risk of bleeding, and efforts on pre-circumcision education of the families might ameliorate unexpected visits. Exlcuding patients with hidden penis or performing penoscrotal skin tacking at the time of the gomco circumcision could decrease concealment rates in the higher risk patients. CONCLUSIONS: Gomco clamp circumcision is safe in patients over 5.5 kg and older than 3 months, with a less than 1% higher risk of bleeding, which in the current study was controlled without the need for general anesthesia or transfusions. Broadening the inclusion criteria for office clamp circumcisions could reduce costs and make the procedure available to patients who cannot afford to have the surgery under general anesthesia.

Evaluation of the Urinary System Diseases Sections in the Book Cerrahiyetü'l Haniyye (Imperial Surgery) by Sabuncuoglu Serefeddin.

OBJECTIVES: Serefeddin Sabuncuoglu (1385-1465) is a medical scholar who wrote the first illustrated surgical book (Cerrahiyetü'l Haniyye [Imperial Surgery]) in the history of Turkish and Islamic medicine. Sabuncuoglu benefited from the books of medical scholars before him and translated the book et-Tasreef of Abul-Qasim Khalaf Ibn Abbas Alzahrawi (Albucasis), which was the most important surgical book of its time. In this study, the urinary system disease sections of the textbook by Serefeddin Sabuncuoglu were examined. MATERIALS AND METHODS: Cerrahiyetü'l Haniyye and et-Tasreef were evaluated by comparative textual analysis methodology in terms of urinary system diseases and its treatments. RESULTS: The textbooks contain the same definitions of the cauterization of the kidney, cauterization of the urinary bladder, the treatment of urine retention, bladder irrigation with the syringe, and the forms of the instruments for the extraction of a stone from men and women. Serefeddin Sabuncuoglu made additions to the kidney and bladder cauterization and bladder irrigation sections. Colorful miniatures containing images of the procedures performed on the patients are found in Cerrahiyetü'l Haniyye. CONCLUSIONS: The urinary system disease section in Cerrahiyetü'l Haniyye is a translation of et-Tasreef in general, with some additional information and drawings. The surgical instruments and procedures described by both physicians have reached the present day with changes.

Morbidity and etiology-based success rate of combined endoscopic ventriculostomy and choroid plexus cauterization: a systematic review and meta-analysis of 1918 infants.

Approaches to the treatment of infant hydrocephalus vary among centers. Standard shunting carries a significant infection rate, an unpredictable time-to-failure, and the life-long risk of recurrent failures. Combined choroid plexus cauterization (CPC) and endoscopic third ventriculostomy (ETV) have been increasingly employed over the past decade as an alternative approach in an attempt to avoid shunt dependency. We performed a systematic review and meta-analysis to explore the reported morbidity associated with ETV/CPC and its rate of success reported for specific etiologies of infant hydrocephalus. The protocol of this study was registered with the International prospective register of Systematic Reviews (PROSPERO) with the following registration number: CRD 42022343898. The study utilized four databases of medical literature to perform a systematic search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Several parameters were extracted from the included studies including authors, publication year, region, study design, sample size, mean age, success rate, complication rate, reported complications, hydrocephalus etiology, median time-to-failure, secondary management after failure, and mean follow-up time. The outcomes of interest, success, and complication rates were pooled using 95% confidence intervals (CI) and a random effects model. Heterogeneity was assessed using the I2 test. Twenty-eight studies met the inclusion criteria from an initial search result of 472 studies. The study included 1938 infants (1918 of which were included in the meta-analysis). The overall success rate of combined ETV/CPC is 0.59 (95% CI (0.53, 0.64), I2 = 82%). Etiology-based success rate is 0.71, 0.70, 0.64, and 0.52 for aqueductal stenosis, myelomeningocele, postinfectious hydrocephalus, and posthemorrhagic hydrocephalus, respectively. The overall complication rate is 0.04 (95% CI (0.02, 0.05), I2 = 14%). Our study presents a comprehensive analysis of the current evidence on the use of ETV/CPC for treating hydrocephalus in infants. The findings demonstrate the potential efficacy of this procedure; however, it is crucial to acknowledge the limitations inherent in the included studies, such as selection bias and limited follow-up, which could have impacted the reported outcomes.

Risk of post-vasectomy infections in 133,044 vasectomies from four international vasectomy practices.

OBJECTIVES: To estimate the risk of post-vasectomy infections in various settings and across various surgical techniques and sanitization practices. PATIENTS AND METHODS: Retrospective review of the records of 133,044 vasectomized patients from four large practices/network of practices using the no-scalpel vasectomy (NSV) technique in Canada (2011-2021), Colombia (2015-2020), New Zealand (2018-2021), and the United Kingdom (2006-2019). We defined infection as any mention in medical records of any antibiotics prescribed for a genital or urinary condition following vasectomy. RESULTS: Post-vasectomy infection risks were 0.8% (219 infections/26,809 procedures), 2.1% (390/18,490), 1.0% (100/10,506), and 1.3% (1,007/77,239) in Canada, Colombia, New Zealand, and the UK, respectively. Audit period comparison suggests a limited effect on the risk of infection of excising a short vas segment, applying topical antibiotic on scrotal opening, wearing a surgical mask in Canada, type of skin disinfectant, and use of non-sterile gloves in New Zealand. Risk of infection was lower in Colombia when mucosal cautery and fascial interposition [FI] were used for vas occlusion compared to ligation, excision, and FI (0.9% vs. 2.1%, p<0.00001). Low level of infection certainty in 56% to 60% of patients who received antibiotics indicates that the true risk might be overestimated. Lack of information in medical records and patients not consulting their vasectomy providers might have led to underestimation of the risk. CONCLUSION: Risk of infection after vasectomy is low, about 1%, among international high-volume vasectomy practices performing NSV and various occlusion techniques. Apart from vasectomy occlusion technique, no other factor modified the risk of post-vasectomy infection.

Comparison of the effect of the harmonic scalpel and monopolar cautery in transaxillary endoscopic dual-plane breast augmentation.

BACKGROUND: Transaxillary endoscopic dual-plane breast augmentation is becoming increasingly mature. The intraoperative separation of the implant into the space is often performed using monopolar cautery. The use of the harmonic scalpel has proved more beneficial in several surgeries. However, no study has ever addressed the effects of harmonic scalpel usage compared to monopolar cautery in transaxillary endoscopic dual-plane breast augmentation. METHODS: In this randomized controlled study, we enrolled patients (n = 78) who underwent breast augmentation in our hospital from January to October 2022. Participants were randomized with an intentional unequal allocation ratio (2:1 in the harmonic scalpel group: monopolar cautery group). Outcome measures included: total postoperative drainage volume, postoperative drainage volume for the first 24 h, number of postoperative drainage days, daily pain scored through the visual analog scale, operative time, and reoperation rate. RESULTS: A total of 51 patients in the harmonic scalpel group and 24 patients in the monopolar cautery group were analyzed. Overall, in comparison to the monopolar cautery group, the harmonic scalpel group showed improved total postoperative drainage volume, postoperative drainage volume for the first 24 h, number of postoperative drainage days, and postoperative pain scores. No differences were found regarding operative time and reoperation rate. CONCLUSION: Compared with monopolar cautery, harmonic scalpel usage in transaxillary endoscopic breast augmentation has evident advantages regarding postoperative drainage and patients' pain scores, making it an instrument worth of recommendation.

Endoscopic Sphenopalatine Artery Cauterization in the Management of Recurrent Posterior Epistaxis.

Background and Objectives: Endoscopic sphenopalatine artery cauterization (ESPAC) has become a reliable and effective surgical procedure for managing posterior epistaxis. The objectives of our study were to evaluate the effectiveness of ESPAC in the management of posterior epistaxis and the possible factors that lead to the failure of the procedure. Materials and Methods: We performed a retrospective analysis of all patients who underwent ESPAC between 2018 and 2022. We retrospectively reviewed the demographic data, patients' co-morbidities, medical treatment conditions, whether other surgical procedures were performed in addition to the ESPAC, and the success rate of ESPAC. Results: 28 patients were included in our study. After ESPAC, epistaxis was successfully managed in 25 patients (89.28%). Of all patients undergoing ESPAC, three (10.7%) presented re-bleeding. In two patients, we performed an endoscopic revision surgery with re-cauterization of the sphenopalatine foramen area, together with anterior and posterior ethmoidectomy, followed by fat occlusion/obliteration of these sinuses. In one patient, fat obliteration of the anterior and posterior ethmoid was also unsuccessful, and we performed an external carotid artery ligation at the level of the neck with no recurrence afterwards. Conclusions: Endoscopic cauterization of the sphenopalatine artery remains a safe, effective, and reliable surgical procedure in the management of recurrent posterior epistaxis. The use of anticoagulant drugs and the association of hypertension and other heart and liver diseases do not materialize as factors influencing surgical failure.

Endoscopic Suture With Chemocauterization: An Effective Treatment of Congenital Pyriform Sinus Fistula.

OBJECTIVE: Endoscopic cauterization is an effective method for treating pyriform sinus fistula (PSF). However, these approaches sometimes result in a higher failure rate. We present an effective technique utilizing suture combined with chemocauterization as first-line treatment in patients with PSF and evaluate the safety and efficacy of its use in 126 patients. STUDY DESIGN: Retrospective study. SETTING: Tertiary referral center. METHODS: Retrospective case review of patients treated between March 2012 and June 2021 at our institution with descriptive statistical analysis. RESULTS: A total of 126 patients with PSF were included in this study with a mean age of 14.7 years. There was no sex predilection. The majority of patients presented with a left-sided neck lesion (89.7%). Ten patients presented following prior attempts at the surgery of the PSF at another institution; 8 via open surgery and 2 following endoscopic CO2 laser cauterization; other patients only had a history of repeat incision and drainage or antibiotic treatment. The success rate of obliteration of the internal opening was 96.83% after a single treatment without complications. Following reoperation, a successful outcome was achieved in the remaining 4 patients. Length of stay ranged from 10 to 14 days. No recurrences occurred within 12 to 120 months followed-up. CONCLUSION: Endoscopic suture combined with chemocauterization is a safe and effective treatment of PSF. Surgery can be performed during the acute cervical inflammatory period without increased risk of complication or recurrence, however, patients found to have acute changes affecting the pyriform sinus should be treated with a staged surgery strategy.

Treatment of canine spontaneous chronic corneal epithelial defects (SCCEDs) with corneal thermal cautery: A retrospective study of 89 cases.

PURPOSE: To evaluate the clinical course and outcome of canine spontaneous chronic corneal epithelial defects (SCCEDs) treated with a combination of cotton-tip epithelial debridement (ED) and corneal thermal cautery (CTC), with or without diamond burr debridement (DBD). METHODS: Retrospective medical record review was used to identify dogs treated for SCCEDs at the Veterinary School of Toulouse between 2001 and 2021. The variables identified included signalment, history, clinical findings, previous treatments, and outcomes. Surgery was performed under manual restraint after topical anesthesia of the cornea. The outcome endpoints included healing, clearing of the cornea and complications. RESULTS: Seventy-seven dogs (89 eyes) from 28 different breeds fulfilled the inclusion criteria. The mean age was 8.78 years. The overall success rate after one procedure was 65.1% with a mean healing time of 15.4 days, but 21 eyes lost to follow-up after the initial treatment, were not included in calculations. There was no significant effect of age, eye, brachycephalic conformation and previous treatments. No significant differences in healing rates were found between groups that received DBD or not. Fifteen eyes (22.7%) underwent a second procedure. Complications (corneal pigmentation, uveitis, corneal bullae, and corneal infection) were observed in 15 cases (22%), with only two cases of complicating melting ulcer. CONCLUSIONS: CTC is a safe and effective treatment for SCCEDs in dogs and can be performed without general anesthesia. Additional DBD does not bring any significant value to CTC in SCCEDs. CTC could be interesting in cases where other procedures are less desirable.

Factors affecting Naseptin treatment success - A prospective cohort study.

OBJECTIVE: To assess patient factors to predict treatment success of Naseptin for recurrent paediatric epistaxis. METHODS: This prospective cohort study of paediatric patients referred to a tertiary paediatric otolaryngology clinic with recurrent epistaxis treated with Naseptin cream and education. Patients with red flag symptoms and bleeding diathesis were omitted, along with patients with concurrent otolaryngology complaints. Statistical analysis included logistic regression analysis to assess for predictive factors contributing to treatment success. RESULTS: 125 of 210 patients on the waiting list met the inclusion criteria and were given a complete trial of Naseptin. 80.8% (n = 101) of patients found that the frequency and severity of epistaxis had reduced, with the remaining 19.2% (n = 24) reporting that the episodes of epistaxis remained the same and required further management (i.e., silver nitrate cautery). Five patients (4%) reported minor side effects (skin irritation etc.) with no significant adverse events reported. CONCLUSION: We found that Naseptin is a safe, well-tolerated treatment that should be trialled in most cases of recurrent paediatric epistaxis. Most children will benefit from it with complete epistaxis cessation or at least reduced frequency and severity.

OUTCOMES OF SEPTOPLASTY IN CHILDREN.

OBJECTIVE: Aim: The aim of the study was to present the experience of a local hospital surgical department where septoplasty is performed on children suffering from its degeneration. PATIENTS AND METHODS: Materials and methods: A retrospective cohort study with 100 patients aged between 3 and 18 years were taken. Both males and females out of 100 patients were followed up for 7 years. The patients were treated with using septoplasty as well as the related clinical procedures such as cauterization of the inferior turbinate. We performed clinical evaluation and nasal endoscopy of the cases in the postoperative period. The longest observation period was 7 years. RESULTS: Results: The male and female child enrolled in the study were 60 (60%) and 40 (40%), respectively. Out of this number of patients, 92 (92%) had inferior turbinate cauterization. In all the 100 cases, we did not notice any intraoperative complication. Also, all the cases were evaluated in 15th, 30th, and 60th days of observation. CONCLUSION: Conclusions: When performed correctly, septoplasty in children is a good clinical intervention as it allows the right growth and development of the crani-ofacial region and prevents abnormalities in psychic and somatic components in young patients. Moreover, this study confirms the previous studies that have demystified the point of view, that the setoplasty should only be recommended when the patients reach the ages of 17 and 18.

Endoscopic third ventriculostomy with choroid plexus cauterization: predictors of long-term success and comparison with shunt placement for primary treatment of infant hydrocephalus.

OBJECTIVE: Endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) can avoid ventriculoperitoneal shunt (VPS) dependence in very young hydrocephalic children, although long-term success as a primary treatment in North America has not been previously reported. Moreover, optimal age at surgery, impact of preoperative ventriculomegaly, and relationship to prior cerebrospinal fluid (CSF) diversion remain poorly defined. The authors compared ETV/CPC and VPS placement for averting reoperation, and they evaluated preoperative predictors for reoperation and shunt placement after ETV/CPC. METHODS: All patients under 12 months of age who underwent initial hydrocephalus treatment via ETV/CPC or VPS placement at Boston Children's Hospital between December 2008 and August 2021 were reviewed. Analyses included Cox regression for independent outcome predictors, and both Kaplan-Meier and log-rank rank tests for time-to-event outcomes. Cutoff values for age and preoperative frontal and occipital horn ratio (FOHR) were determined with receiver operating characteristic curve analysis and Youden's J index. RESULTS: In total, 348 children (150 females) were included with principal etiologies of posthemorrhagic hydrocephalus (26.7%), myelomeningocele (20.1%), and aqueduct stenosis (17.0%). Of these, 266 (76.4%) underwent ETV/CPC and 82 (23.6%) underwent VPS placement. Treatment choice largely reflected surgeon preferences before practice shifted toward endoscopy, with endoscopy not considered for > 70% of initial VPS cases. ETV/CPC patients trended toward fewer reoperations, and Kaplan-Meier analysis estimated that 59% of patients would achieve long-term shunt freedom through 11 years (median 42 months of actual follow-up). Among all patients, corrected age < 2.5 months (p < 0.001), prior temporizing CSF diversion (p = 0.003), and excess intraoperative bleeding (p < 0.001) independently predicted reoperation. Among ETV/CPC patients, corrected age < 2.5 months (p = 0.031), prior CSF diversion (p = 0.001), preoperative FOHR > 0.613 (p = 0.011), and excessive intraoperative bleeding (p = 0.001) independently predicted ultimate conversion to VPS. The actual VPS insertion rates remained low in patients who were ≥ 2.5 months old at ETV/CPC either with prior CSF diversion (2/10 [20.0%]) or without prior CSF diversion (24/123 [19.5%]); however, the actual VPS insertion rates increased in patients who were < 2.5 months old at ETV/CPC with prior CSF diversion (19/26 [73.1%]) or without prior CSF diversion (44/107 [41.1%]). CONCLUSIONS: ETV/CPC successfully treated hydrocephalus in most patients younger than 1 year irrespective of etiology, averting observed shunt dependence in 80% of patients ≥ 2.5 months of age regardless of prior CSF diversion and in 59% of those < 2.5 months of age without prior CSF diversion. For infants aged < 2.5 months with prior CSF diversion, particularly those with severe ventriculomegaly, ETV/CPC was unlikely to succeed unless safely delayed.

Application of Bipolar Cauterization During Standard Percutaneous Nephrolithotomy.

Introduction: We aimed to evaluate the efficacy of bipolar cauterization for tract site bleeding during standard percutaneous nephrolithotomy (PCNL). Methods and Materials: We defined tract site bleeding as when the visual field across the parenchymal tract starts to bleed while the sheath of a balloon dilator is being withdrawn just before the operation is completed. Among 181 patients, 90 patients showed no significant bleeding, and 91 patients required further procedures to resolve tract site bleeding. In cases of unresolved tract site bleeding, either nephrostomy placement (n = 60) or cauterization (n = 31) was performed. The outcomes of three groups (no procedure group, nephrostomy group and cauterization group) were compared. Results: The median decrease in hemoglobin at 2-hour intervals postoperatively was -1.75, -1.0, and -0.2 in the nephrostomy, cauterization, and no procedure groups, respectively (P < .001). There were 25 patients (41.7%) who received transfusions in the nephrostomy group, whereas only 1 patient (3.2%) received a transfusion in the cauterization group (P < .001). Conclusion: The bipolar cauterization of bleeding points at the end of PCNL could efficiently decrease tract site bleeding and reduce the need for transfusion. Clinical Research Information Service (https://cris.nih.go.kr/cris; No. KCT0008303).