Medicina
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Bleeding is a rare but serious complication of pancreatitis, significantly increasing morbidity and mortality. It can arise from various sources, including erosion of blood vessels by inflammatory processes, formation of pseudoaneurysms, and gastrointestinal bleeding. Early diagnosis and timely intervention are crucial for patient survival. ⋯ Management strategies for patients with extraluminal bleeding may involve angioembolization or surgical intervention, depending on the severity and location of the bleeding. While advances in diagnostic and therapeutic techniques have improved outcomes, bleeding in pancreatitis remains a challenging clinical problem requiring a multidisciplinary approach. This review aims to focus its attention specifically on the bleeding complications of pancreatitis.
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Observational Study
Differences in Characteristics of Peripartum Patients Who Did and Did Not Require an Upgrade to the Intensive Care Unit: A Propensity Score Matching Study.
Background and Objectives: This study sought to identify predictors for peripartum patients admitted to non-intensive care wards who later upgraded to the Intensive Care Unit (ICU). Materials and Methods: This was a retrospective observational study of patients admitted to the Maternal Fetal Ward between 01/2017 and 12/2022, who later upgraded to the ICU. Upgraded patients were 1:1 propensity score matched with those who remained on the Maternal Fetal Ward (control). ⋯ The APACHE II score was also associated with ICU upgrade within 12 h of hospital admission (OR 1.4, 95% CI 1.08-1.91, p = 0.01). Conclusions: Compared to control patients, peripartum patients upgraded to the ICU are associated with higher physiologic scores at Maternal Fetal Ward admission. Until further studies are performed to confirm our observation, clinicians should pay attention to these physiologic scores, since they may be associated with higher-risk patients.
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Case Reports
Sandwiched Strut Allografts with Stem Retention to Treat Fragile Periprosthetic Femoral Fractures: A Case Report.
Managing periprosthetic femoral fractures is challenging, particularly in osteoporotic patients with fragile bones. Revision with a long stem is commonly considered but may fail to provide adequate fixation and stability in fragile bones. A novel approach using sandwiched strut allografts and controlled bone crushing with robust cable fixation can offer mechanical support and provide secondary stability to the loosened femoral stem and can be considered a treatment option for low-demand patients. ⋯ Postoperative imaging at 18 months confirmed successful bone union and implant stability, and the patient regained preoperative functional capacity without pain. This case demonstrates that partially crushing native bone with dual strut allografts may provide stability to the loosened femoral stem and can be an effective alternative to long-stem revision surgery for patients with highly fragile bones. This approach may provide immediate mechanical stability and can be a potential treatment option for managing fragile periprosthetic femoral fractures.
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Background and Objectives: Persistent exposure to airborne fine dust (FD) particles contributing to air pollution has been linked to various human health issues, including respiratory inflammation, allergies, and skin diseases. We aimed to identify potential seaweed anti-inflammatory bioactive reagents and determine their effects on systemic inflammatory responses induced by FD particles. Materials and Methods: While exploring anti-inflammatory bioactive reagents, we purified compounds with potential anti-inflammatory effects from the seaweed extracts of Ecklonia cava, Ecklonia stolonifera, and Codium fragile. ⋯ Additionally, gene profiling revealed the early activation of various signature genes involved in the production of inflammatory cytokines and chemokines using gene profiling. Treatment with PFF-A markedly reduced the expression levels of pro-inflammatory and apoptosis-related genes and even elevated the Bmp gene families. Conclusions: These results suggested that PFF-A is a potential natural therapeutic candidate for managing FD-induced inflammatory response.
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Background and Objectives: Proximal tibiofibular joint detachment (PTFJD) is a fibular untethering procedure during lateral closing-wedge high tibial osteotomy (LCWHTO) for varus knee osteoarthritis. However, the PTFJD procedure is technically demanding, and confirmation of clear joint separation is not straightforward. The aim of this study was to compare the degree of completion and safety of PTFJD versus tibial-sided osteotomy (TSO); this latter procedure is our novel technique for fibular untethering during LCWHTO. ⋯ However, the osteotome was blocked posteriorly by the popliteus muscle in the TSO group cases, indicating protection of posterior neurovascular structures during the TSO procedure. Conclusions: TSO, a novel fibular untethering procedure for LCWHTO, resulted in clear separation of the fibula from the lateral tibial cortex, and protection of posterior neurovascular structures by the popliteus muscle during the procedure. We anticipate that our novel surgical technique will provide more clear-cut and safer fibular untethering for LCWHTO.