A Systematic Review: Fibrin Glue in Drainless Rhytidoplasty.

The following questions guided the study: Can the use of fibrin glue in drainless rhytidoplasty reduce hematoma prevalence, seroma prevalence increase patient satisfaction or decrease the length of hospital in the adult population compared with standard treatment? The following inclusion and exclusion criteria apply: The procedure performed was rhytidoplasty for both groups. Participants were limited to adults who did not have any other procedure performed during the study. The intervention consisted of the use of fibrin glue without drains compared to the control group, in which drains and/or pressure dressing were applied. Databases: clinicaltrials.gov, MEDLINE, COCHRANE, mRCT, PubMed, Google Scholar, Scopus, Embase, VHL, GHL were searched on 03/25/2023 by 2 different investigators. The Cochrane Risk of Bias Tool 2.0 was used. Five studies were included with a total number of 1277 participants (2554 face sides). The cumulative hematoma rate was OR 0.47 (95% CI 0.26-0.84) in favor of using fibrin glue. Insufficient data were available to assess seroma rate, patient satisfaction, and length of hospital stay. The risk of study bias was judged to be low and moderate. The certainty for the use of fibrin sealant versus drainage is high and the importance of outcomes is rated as important in the GRADEpro GDT tool. Fibrin glue use is more beneficial comparing to drainage in patients undergoing rhytidectomy in terms of hematoma prevalence. This study was registered in PROSPERO (CRD42023421475).Level of Evidence I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Renal agenesis: A meta-analysis of its prevalence and clinical characteristics based on 15 641 184 patients.

Our objective was to analyse the newest relevant data on worldwide prevalence and associated symptoms of renal agenesis (RA). This meta-analysis builds on previous systematic reviews to include bilateral RA, its symptoms and data on gender, unilateral RA and anomaly location prevalence. Review of available data included records in English and other languages from PubMed, Embase, ScienceDirect, Web of Science, SciELO, BIOSIS, Current Content Connect Korean Journal Database and Russian Citation Index and Google. A total of 15 641 184 patients were analysed in relation to the prevalence of RA. The pooled prevalence of RA was 0.03% (95% CI: 0.03%-0.04%). Based on 500 subjects, a pooled prevalence of 47.96% (95% CI: 31.55%-64.58%) for unilateral and 52.04% (95% CI: 35.42%-68.45%) for bilateral RA has been set. Our study presents the newest generalized findings on bilateral RA. There appears to be universal disease and symptom prevalence with minor differences between world regions, although quality of future observational research should include genomic data. This will provide even further insight into the prognosis of various renal anomalies and their etiologies.

The arterial anatomy of the posterior duodenum - A computed tomography angiography analysis with implications for abdominal surgery.

The main objective of the present study was to clarify the anatomical characteristics of the GDA. In order to fulfill this objective, novel classification systems of both the origin and branching pattern of the said vessel were created. Being aware of the variable anatomy of the GDA is of great importance when performing hepatopancreaticobilliary procedures. The results of 75 consecutive patients who underwent abdomen computed tomography angiography (CTA) were analyzed. A total of 74 GDA were analyzed. Of these, 42 were from women (56.8%) and 32 were from men (43.2%). The most common direction of origin of the GDA was inferior (n = 38; 51.4%). The origin variation of each GDA was deeply analyzed. Initially, eight types of origin variations were evaluated, of which types 1-3 constituted 83.8%. Furthermore, analogously, branching pattern types were also established. Initially, 11 branching variations were evaluated, of which types 1-3 constituted 87.8%. The GDA is subject to numerous variations, both in the origin and in the branching pattern of the vessel. In order to clarify the anatomical characteristics of this vessel, novel classifications of the origin and branching patterns were made, presenting the most frequent patterns. Our results may be of great use for surgeons performing hepatopancreaticobilliary surgeries, such as the Whipple procedure or vascular reconstructions after cholangiocarcinoma resections. Being aware of the anatomical variations of relevant structures associated with a surgical procedure may help reduce potential intraoperative and/or postoperative complications.

Termination points of the facial artery-A meta-analysis.

The facial artery (FA) is the main artery supplying the anterior face, making this artery a very important structure to consider while performing plastic and reconstructive procedures. The literature shows discrepancies in anatomical classifications and the frequency of occurrence of individual variations. Therefore, the goal of this meta-analysis is to provide surgeons with helpful knowledge about the variety of the termination of FA. Articles with data about the termination of the FA were found in major online medical databases such as PubMed, Scopus, Embase, Web Of Science, and Cochrane Library. A total of 1346 articles were initially evaluated by two independent reviewers. Out of those, 24 articles matched the required criteria, and were used in this meta-analysis. A total of 2119 studied FAs were included in this study. The FA termination patterns were divided into five previously classified types. The data show that the FA terminates most frequently as the lateral nasal or angular artery with the prevalence for this group being 69.81% (95% confidence interval [CI]: 59.83%-78.94%). Authors believe that this is the most accurate and up to date study regarding termination patterns and the prevalence of the FA. The results of this meta-analysis could provide a helpful tool for surgeons preforming plastic and cosmetic procedures, especially when injecting dermal fillers or choosing and preforming facial flaps. Detailed anatomical knowledge about the FA may prevent potential surgical complications.

Telocytes in the architecture of uterine fibroids.

Knowledge of uterine fibroids has existed since the time of Hippocrates. However, there are still wide gaps in the understanding of its pathogenesis. No single theory explains the background of uterine fibroid pathology, which affects more than 50% of women worldwide. By contrast, a newly depicted cell type called telocytes was only recently identified in the past twenty years. These cells have evoked ambivalent opinions in the scientific community. The unique features of telocytes coupled with experimental evidence by numerous researchers and our hypotheses and conceptions are discussed in this review. We emphasize the main telocyte interactions in the context of the uterine fibroid architecture. This review reveals the pivotal role of telocytes, describing their contacts with smooth muscle cells, fibroblasts, vessels and nerves, inflammatory cells and stem cells. Our data are based on the latest publications and our own results.

Measurement of the cerebral saturation for assessment of safety of epidural anaesthesia during abdominal surgery.

BACKGROUND: Near Infrared Spectroscopy (NIRS) is considered a reliable assessment method of a balance between cerebral oxygen demand and supply. One of forms of anaesthesia applied during extensive abdominal surgical procedures is the epidural anaesthesia. Its application in addition to the general anaesthesia is a commonly accepted form of anaesthesia in patients undergoing abdominal surgery. The aim of this study was to verify the hypothesis that epidural blocks may have effects on cerebral saturation in patients undergoing abdominal surgery under general anaesthesia. METHODS: Cerebral saturation was monitored intrasurgically. Reduction of cerebral oxymetry by over 25% in relation to the baseline, or cerebral oxymetry value below 50% was considered clinically significant. RESULTS: One hundred and one (101) subsequent and non-randomised patients, age between 35 and 84 years (mean 64 ± 10) qualified for major abdominal surgeries were enrolled. In 14 (13.9%) patients of 101 enrolled a clinically significant reduction of cerebral saturation was observed. In 50 (49.5%) of the enrolled patients, the epidural anaesthesia was applied along the general anaesthesia. A clinically significant reduction of cerebral saturation was observed in 9 of them. No statistically significant association was found between the application of epidural anaesthesia and development of cerebral desaturation. CONCLUSION: The application of epidural anaesthesia caused no clinically significant reduction of cerebral saturation during the general anaesthesia in course of major abdominal surgical procedures.

Relation between ureteral telocytes and the hydronephrosis development in children.

INTRODUCTION: Hydronephrosis is an actual pediatric problem, affecting children in the ante- and neonatal periods. Intrinsic stenosis is due to external obstruction and creates a pathophysiological basis of this urological pathology. Co-localization of ureter with a renal vasculature also could not be omitted from this point of view. Mesenchymal cells, partially telocytes, are important for local fibrosis development and hydronephrosis formation as well. In the current study, we focused on identification of telocytes in the human ureters to hypothesize their role in hydronephrosis pathophysiology. MATERIAL AND METHODS: the samples were taken from 18 surgically treated patients with hydronephrosis (due to ureteral obstruction and crossing renal vessel). The control group consisted of 10 patients suffered from a non-obstructive disease of the urinary tract - predominantly renal tumors. Tissue samples from a ureter were stained for c-kit, tryptase, CD34 and PDGFRα to identify telocytes. Routine histology was performed to analyze tissue morphology, collagen deposits and mast cell's profile. RESULTS: Telocytes were detected in the ureteral wall. In patients with hydronephrosis we revealed decreasing density of telocytes, the prevalence of collagen, rise in mast cells amount and the ureteral wall thickening. In ureters with crossing renal vessels as a primary etiologic factor more telocytes have been observed in comparison with the obstructive hydronephrosis. CONCLUSIONS: A declined density of telocytes accompanied hydronephrosis development. Increased number of mast cells in the ureteral wall reflects a local inflammation, while detailed observation of collagen/muscle deposits and density of telocytes reveal a difference depended on etiologic factor (obstruction or crossing vessel) in patients with hydronephrosis.

Identification of uterine telocytes and their architecture in leiomyoma.

INTRODUCTION: Uterine leiomyoma is the most widespread benign tumor affecting women of childbearing age. ere are still gaps in the understanding of its pathogenesiss. Telocytes are unique cells described in greater than 50 different locations inside the human body. The functional relationship of cells could clarify the pathogenesis of leiomyomata. In the current study, we focused on the identification of telocytes in all regions of the human uterus to explain their involvement in leiomyoma development. MATERIALS AND METHODS: Tissue samples from a healthy and myomatous uterus were stained for c-kit, tryptase, CD34 and PDGFRα to identify telocytes. Routine histology was performed to analyze tissue morphology and collagen deposits. RESULTS: Telocytes were detected in the cervix, corpus of the uterus and leiomyoma. The density of telocytes in fibroid foci was reduced compared with normal myometrium. CONCLUSIONS: Our results demonstrated the existence of telocytes in all parts of the human body affected and unaffected by leiomyoma of the uterus. In addition, telocytes were also present in leiomyoma foci. Our results suggest that the reduced density of telocytes is important for the pathomechanisms of myometrial growth, demonstrating its value as a main component of the myomatous architecture.

Accuracy of preoperative tumor localization in large bowel using 3D magnetic endoscopic imaging: randomized clinical trial.

BACKGROUND: Laparoscopic surgery has become the standard treatment for colorectal cancer. A tumor that does not involve serosa is invisible intraoperatively, and manual palpation of the tumor during laparoscopy is not possible. Therefore, accurate localization of the neoplastic infiltrate remains one of the most important tasks prior to elective laparoscopic surgery. The aim of this study was to evaluate the utility of a magnetic endoscopic imaging (MEI) for precise preoperative endoscopic localization of neoplastic infiltrate within the large bowel. MATERIALS AND METHODS: The study enrolled 246 patients who underwent elective surgery for colorectal cancer in 2012-2015 with accurate preoperative colonoscopic localization of the tumor. The analysis concerned patients with neoplastic infiltrate localized more than 30 cm from the anal verge. For evaluative purposes and accuracy of localization, the intestine was divided anatomically into 13 parts. Colonoscopic examinations were conducted with two types of endoscopes: group I-with MEI and group II-without MEI. Patients were assigned to the groups by random allocation. Ultimate confirmation of the tumor localization was accomplished by intraoperative evaluation. RESULTS: Group I involved 127 patients and group II 129. The two groups were compared in terms of age, sex, BMI and frequency of previous abdominal procedures. Proper localization of the lesion was confirmed in 95.23 % of group I patients and in 83.19 % of group II patients (p < 0.05). The greatest discrepancy in localization occurred in 8.9 % of patients from group I and 20 % of patients from group II in which the lesion was assessed primarily in the distal sigmoid. CONCLUSIONS: A magnetic endoscopic imaging allows more accurate localization of neoplastic infiltrate within the large intestine compared to standard colonoscopy alone, especially within the sigmoid colon. This method can be particularly useful in planning and performing laparoscopic procedures to diminish the likelihood of improper bowel segment resection. CLINICALTRIALS. GOV NUMBER: NCT01688557.

Impact of responsive insertion technology (RIT) on reducing discomfort during colonoscopy: randomized clinical trial.

BACKGROUND: In many countries, colonoscopies for colorectal cancer screening are performed without sedation due to the cost. Changes in the structure of the endoscopes are designed to facilitate the colonoscopic examination, reduce the duration of the procedure, and improve the imaging of the intestinal lumen. The variable stiffness of the endoscope and the recently introduced responsive insertion technology (RIT) are features aimed at easing colonoscope insertion and reducing the discomfort and pain during the examination. The aim of the study is to analyze whether the new RIT system can improve the practice of colonoscopy under no anesthesia with respect to the widely available variable stiffness colonoscopes. MATERIALS AND METHODS: This analysis included 647 patients who underwent complete colonoscopy in the screening program. All colonoscopies were performed without sedation. Olympus series 180 and 190 endoscopes equipped with a magnetic positioning system were used. Group I included patients who were examined using endoscopes equipped with responsive insertion technology (RIT), and group II included patients who were examined using conventional variable stiffness colonoscopies. The main objective was to evaluate the cecal intubation time, the number of loops, the requirement to apply manual pressure to different areas of the abdomen and the degree of discomfort and pain expressed on a visual analogue scale (VAS). ClinicalTrials.gov number, NCT01688557. RESULTS: Group I consisted of 329 patients, and group II included 318 patients. The mean age of the patients was 58.4 years (SD ± 4.21). Both groups were compared in terms of age, sex, and BMI. The mean cecal intubation time was 209 s in group I and 224 s in group II (p < 0.05). Increased loop formation was observed upon endoscope insertion in group II (1.7 vs. 1.35) (p < 0.05) and required more manual pressure to the abdomen (2.2 vs. 1.7) (p = 0.001). In group I, less discomfort and pain, as graded on a VAS (2.3 vs. 2.6), were noted. CONCLUSIONS: The implementation of RIT reduced of the cecal intubation time. The modified structure of the endoscope rendered the colonoscopic examination easier by reducing loop formation upon insertion with a subsequently reduced rate of auxiliary maneuvers.

Telocytes: facts, speculations and myths (Review article).

Telocyte (TC) is an interstitial cell type with a small cellular body and extremely long tentacle-like extensions. TCs were discovered a decade ago and have specifc morphological characteristics, immunohistochemical and secretome profiles, electrophysiological properties, microRNA expression. Moreover, they are different in gene expression from other cells. TCs play an important role in plenty of processes. Apparently, they are involved in homeostasis, remodelling, regeneration, repair, embryogenesis, angiogenesis and even tumorigenesis. "Telocytes need the world", was emphasized by Professor Popescu and it will be actual at any time. This review summarizes particular features of TCs in different organs and systems, emphasizing their involvement in physiological and pathophysiological processes.

Residua of thymus in the mediastinum - clinical aspects - cadaveric study.

The main goal of this study was to investigate possible residua of thymic tissue in 100 adult cadavers with no thoracic pathology known before, by dissection of standard locations of thymic tissue in perithyroid, periaortic, peritracheal and retrotracheal spaces, as well as areas located next to the course of phrenic, vagus and left recurrent laryngeal nerves. Thus obtained tissue samples were studied by two pathologists independently. The remnants of the thymic tissue were found in 61 out of 100 specimens studied. It means that residua of ectopic thymic tissue is common, which may have a huge impact on the results of treatment of many diseases i.e. myasthenia gravis in course of thymoma.

Two-stage optical system for colorectal polyp assessments.

BACKGROUND AND AIMS: Macroscopic real-time evaluations of the histopathology and degree of invasion of colorectal polyps help to select the most suitable endoscopic treatment method. Dual-focus (DF) narrow-band imaging (NBI) is a new imaging enhancement system that uses digital and optical methods to enhance the view of blood vessels on mucosal surfaces. However, the superiority of this technique over standard imaging techniques has not been previously reported. The aim of this study was to determine whether the two-stage optical systems in a new generation of endoscopes will increase the diagnostic accuracy of colorectal polyp recognition. METHODS: The study included 270 patients, and 386 colorectal polyps were diagnosed and removed. The polyps were assessed with white light and NBI using one- and two-stage optical systems, respectively. After being classified according to the Kudo pit pattern schemes, the polyps were removed and histopathologically verified. RESULTS: Regarding non-neoplastic lesions (Kudo I and II), no difference was observed in the recognition of polyps when using the NBI-DF function. We observed improved accuracy in the preliminary diagnoses of Kudo IIIL lesions (from 87.16 to 90.09%, p < 0.05) and Kudo IIIS lesions (from 87.29 to 92.79%, p < 0.01). NBI-DF also increased the accuracy of preliminary diagnoses of Kudo IV lesions (from 88.24 to 94.12%, p < 0.01). The Kudo V pit patterns were also more distinct with NBI-DF imaging, increasing the diagnostic accuracy from 91.67 to 100%. CONCLUSIONS: Using a two-stage optical system with electronic colorization of the mucosa increased diagnostic accuracy for differentiating colorectal polyps with neoplastic potential.

Telocytes: New Players in Gallstone Disease.

Cholesterol gallstone disease is highly prevalent in Western countries, particularly in women and some specific ethnic groups. The mechanisms behind the formation of gallstones are not clearly understood, but gallbladder dysmotility seems to be a key factor that triggers the precipitation of cholesterol microcrystals from supersaturated lithogenic bile.Given that newly described interstitial cells, telocytes, are present in the gallbladder and they are located in close vicinity of smooth muscle cell and neural fibers possibly interfering with gallbladder motility or contractility, authors are trying to summarize the current knowledge on the role of telocytes with respect to disturbed gallbladder function in gallstone disease.

A giant pancreatic pseudocyst treated by open cystogastrostomy.

We report a case of a giant pancreatic pseudocyst in a 33-year-old woman presenting with abdominal pain, loss of appetite and abdominal distension. CT scans revealed a giant pancreatic pseudocyst measuring 10.3 cm × 9.6 cm × 9.3 cm anteroposteriorly, with significant compression of the stomach. An open retrogastric cystogastrostomy was performed through a midline incision, and 3 L of fluid was drained from the pseudocyst. Recovery has been uneventful.

Hiatal hernia with upside-down stomach. Management of acute incarceration: case presentation and review of literature.

Upside-down stomach (UDS) represents the rarest type of hiatal hernia (<5%) and is characterized by herniation of the entire stomach or most gastric portions into the posterior mediastinum. We present here a very rare complication of such a condition which is incarceration of upside-down stomach. A 54 year-old female was admitted to the emergency department presenting signs of acute epigastric pain radiating into thorax. Computed tomography revealed a giant hiatal hernia with incarceration of the gastric trunk. Immediate operation for reduction of the incarcerated stomach and repair of the hiatal defect was performed. The patient was discharged without any complication and was followed up at the surgical outpatient department. The presented case confirms that differentiation of an acute epigastric or intrathoracic pain in adults should always exclude presence of hiatal hernia which in case of incarceration should be treated by prompt surgical management.

Gastroscopy in patients with hiatal hernia with and without gastroesophageal mucosal prolapse.

There are still many doubts in the literature regarding gastroesophageal mucosal prolapse (GEMP) and its clinical course. We still do not know what determines mucosal wedging in esophagogastric junction, and what is the role of the anatomy of that site. To investigate that problem we performed 120 upper digestive tract endoscopies in which a hiatal hernia was diagnosed. Patients referred to our unit with different complaints most frequently of typical or atypical gastroesophageal (GE) reflux symptoms. The aim of that study was to assess hernia dimensions in patients with and without GEMP diagnosed during endoscopy. Additionally we analyzed the type and prevalence of gastrointestinal symptoms reported by patients to confirm the observation that GEMP symptoms differ from gastroesophageal reflux disease (GERD) symptoms. METHODS: One-hundred and twenty patients were included in this study. All of the patients were diagnosed with a hiatal hernia during routine gastroscopy. Using standardized methodology the region of the hiatal hernia was photographed, and hernia longitudinal and transverse dimensions were measured. RESULTS: The study group comprised 57 females (52.5%) and 63 males - mean age (SD) 58.5 ± 18.4. Most of the patients had standard GERD symptoms (n = 96; 80%). The average length of hiatus, in patients with GEMP (n = 24; 20%) was 3.56 ± 0.59 cm, and the average width was 2.32 ± 0.62 cm (n = 96; 80%) vs. 4.64 ± 0.74 cm and 2.98 ± 0.68 cm respectively in patients without GEMP (p <0.001). CONCLUSIONS: GEMP occurs in smaller sized hiatal hernias. We confirmed that disease symptoms of the majority of patients with GEMP differ from patient with GERD but without GEMP. However this difference was not significant enough to allow to differentiate between diagnoses based solely on the symptoms.

Blood vessels of the shin - anterior tibial artery - anatomy and embryology - own studies and review of the literature.

Injuries of the lower leg are rather frequent in every day orthopedic routine. Process of healing takes quite a long time and is commonly dependent on the proper vasculature. e study was carried out on 50 human lower legs obtained during autopsies. The anatomy of the vascular system of the leg was studied using classical anatomical dissection methods. Based also on literature we have reviewed the current knowledge on the vascularization of the lower leg and its embryological background.

A novel in-vitro model of human aortic valve mineralization.

BACKGROUND AND AIM OF THE STUDY: The study aim was to develop an in-vitro model of human aortic valve homograft (AVH) mineralization, as a basis for further research on the subject of calcific aortic valve disease (CAVD). METHODS: Human aortic valves were excised during autopsy (12-24 h post-mortem) from donors who had died due to accident or suicide. The mean (±SD) donor age was 32.5 ± 11.4 years. Under sterile conditions each aortic cusp (three cusps per valve) was cut in half to provide a total of 240 tissue samples. AVH mineralization was assessed in solutions with different Ca and P concentrations and CaxPO4 ionic product values. The impact of time on aortic valve mineralization rate was assessed using energy-dispersive X-ray fluorescence (ED-XRF). RESULTS: The model showed that human AVH mineralization can be best observed in a solution with a CaxPO4 ionic product of 2.2 mmol2/l2. The optimum incubation time for observing AVH mineralization was 21 days. CONCLUSION: A novel in-vitro AVH mineralization model was developed for use in future studies.

Degeneration and calcification of the cervical endplate is connected with decreased expression of ANK, ENPP-1, OPN and TGF-ß1 in the intervertebral disc.

The aim of this study was to clarify the relationship between the expression of ALP, ANK, ENPP-1, OPN and TGF-ß1 in the intervertebral disc (IVD), and cervical vertebral endplate calcification and degeneration. Sixty cervical IVDs were excised from 30 human cadavers. Each cadaver was assessed macroscopically for degeneration (Thompson's classification), and then underwent histological processing, regular staining (hematoxylin and eosin, Masson-Goldner trichrome and alcian blue-PAS), immunohistochemistry (ALP, ANK, ENPP-1, OPN and TGF-ß1), microscopic degeneration grading (Boos classification), and assessment of endplate calcification. The mean age ± SD of the cadavers was 51.4 ±19.5. The percentage of endplate calcification significantly correlated with the degree of endplate and IVD degeneration graded using Boos's score (both r = 0.91; p < 0.0001). The intensity and number of stained cells per FOV markedly decreased, for ANK, ENPP-1, and TGF-ß1, with the grade of IVD degeneration, regardless of the analyzed IVD region. This was not true only for ALP, which demonstrated an increasing trend corresponding to the degree of IVD degeneration. The expression of OPN was low throughout all analyzed regions, regardless of the degree of degeneration. Modulating the expression of the abovementioned proteins, especially ANK and TGF-ß1, may be a new way to prevent degeneration and calcification of the IVD.