Search Results (33)

In Southern Chile, sewer- and septic tank-based sanitation dominates public discourse and expectations, while in practice it often fails under local environmental and social conditions. This study explores the adoption of composting toilets by households as a practical response to these challenges. Drawing on autoethnographic and ethnographic research (2020–2026) in the Los Lagos Region, it examines how people implement composting toilets and the transformative potential and limits of living with these infrastructures. By situating composting toilets within global imaginaries of ecological, sustainable, and circular sanitation, it suggests that they have the potential to act as socioenvironmental cauteries—localized efforts to contain harm and sustain life. Composting toilets in this study reshape relations among excrement, bodies, and environments while depending on individual initiative, technical know-how, and social privilege. Thus, they can reinforce neoliberal rationales of individual responsibility for collective issues that ultimately require structural changes. The study concludes that just and sustainable sanitation requires support for user-driven innovations and the development of frameworks adapted to local socioecological contexts, while actively addressing social inequalities. Full article

Background: Lipomas are common benign subcutaneous neoplasms treated surgically for cosmetic or symptomatic reasons. The minimal one-third incision and four-step (MOTIF) technique provides reliable excision with minimal scarring, but smaller proportional incisions remain unstudied. This study evaluates the minimal one-quarter incision and four-step (MOQIF) technique. Methods: Retrospective review of 82 patients undergoing MOQIF excision of histologically confirmed subcutaneous lipomas by a single surgeon from July 2024–December 2025 was done. Lipomas were stratified by maximum diameter: small-intermediate (<5 cm) and large (≥5 cm). MOQIF used a one-quarter incision of the lipoma’s long axis determined by preoperative ultrasound measurement and palpation with four steps: hydro dissection preserving superficial subcutaneous tissue, superficial dissection, staged deep dissection with selective cautery of fibrovascular septa, and intact mass delivery. Outcomes included excision length, postoperative complications, Vancouver Scar Scale (VSS) scores, recurrence, and subjective treatment satisfaction of patients. Results: Mean lipoma size was 6.8 ± 2.0 cm (75.6% ≥5 cm). All lipomas were completely excised through 1.69 ± 0.49 cm incisions (ratio 0.25). Complications were low: seroma 10.98% (16.7% vs. 9.4%, p = 0.404), hematoma 7.3% (11.1% vs. 6.3%, p = 0.608), with no infections, nerve injuries, or recurrences at a mean 8.9-month follow-up. VSS scores were equivalent between groups (0.83 vs. 1.06; p = 0.438) and overall patient satisfaction was high (3.54 ± 0.53 (2–4)). Conclusions: MOQIF achieves complete lipoma excision through one-quarter incisions with safety and cosmetic outcomes across lipoma sizes, demonstrating feasibility through standardized technique refinement and careful case selection. Full article

Chromoblastomycosis is a chronic mycosis of the skin and subcutaneous tissue typically caused by traumatic inoculation of dematiaceous fungi of the Herpotrichiellaceae. A 59-year-old male presented with a 12-month history of an asymmetrical, scaly plaque on the left forearm that has been slowly increasing in size. Past medical history included atrial fibrillation on apixaban, hypertension and a cardiac stent. A 4 mm punch biopsy of the left forearm revealed superficial dermal fibrosis with mild pseudoepitheliomatous hyperplasia and granulomatous inflammation with scattered multinucleate histiocytes. There were giant cells with dark brown, somewhat round, yeast-like structures, some with internal septation exhibiting moderate staining for PAS, compatible with Medlar bodies suggestive of chromoblastomycosis. The patient was on rosuvastatin, rendering itraconazole not a possible treatment option, and instead the patient underwent curettage and cautery with two bouts of cryotherapy freeze and thaw cycles. A twelve-month follow-up noted a crusted area on the distal aspect of the scar. A shave biopsy of this area revealed pigmented organisms suggesting a recurrence of chromoblastomycosis. A further excisional biopsy was performed, with no evidence of chromoblastomycosis. This case highlights multiple surgical options for the management of chromoblastomycosis in patients where medical management is contraindicated. It highlights the therapeutic challenge of this disease due to frequent recurrence of lesions and that repeat biopsy may be efficacious in monitoring for recurrence. Full article

Objectives: Tonsillectomy is among the most frequently performed pediatric ENT procedures. Post-tonsillectomy pain and hemorrhage remain key determinants of postoperative morbidity and may differ by surgical technique. This work’s objective is to compare postoperative pain, bleeding, and operative duration across three pediatric tonsillectomy techniques: cold dissection with suturing, cold dissection with ligation, and hot dissection with bipolar cautery. Materials and Methods: In this single-center, prospective study, 150 children (n = 50 per group) undergoing tonsillectomy (with adenoidectomy) between October 2022 and October 2024 were assigned preoperatively to the following groups: Group 1—cold dissection + suturing; Group 2—cold dissection + ligation; Group 3—hot dissection (bipolar cautery). Pain was assessed with the Wong–Baker FACES scale at 1, 6, and 24 h, days 3 and 7, and with the Parents’ Postoperative Pain Measure (PPPM) at 1, 6, and 24 h. Primary bleeding was defined within 24 h; secondary bleeding was within 2 weeks. Operative time was recorded from first incision to hemostasis. Non-parametric tests and chi-square analyses were used with p < 0.05 considered significant. Results: Of 150 patients, 58% were male. No primary hemorrhage occurred. Secondary hemorrhage occurred in 4/150 (2.7%): 1/50 (2%) in Group 1, 0/50 (0%) in Group 2, and 3/50 (6%) in Group 3 (overall p > 0.05). Readmission for oral-intake difficulty occurred in 4/150 (2.7%): 1/50 (2%) in Group 1 and 3/50 (6%) in Group 3 (p > 0.05). Operative time differed significantly across groups (Kruskal–Wallis p < 0.05), being longest in Group 1 and shortest in Group 3 (17.53 ± 1.26 min); Group 2 averaged 18.60 ± 0.94 min and Group 1 21.89 ± 1.64 min. Pain decreased over time in all groups (Friedman p < 0.001). Across virtually all time points, Group 2 (ligation) had significantly lower Wong–Baker and PPPM scores than Groups 1 and 3 (Dunn post-hoc, adjusted p < 0.05), while Groups 1 and 3 did not differ consistently. Conclusions: Cold dissection with ligation yielded the most favorable pain profile while maintaining low bleeding rates; hot dissection minimized operative time but tended toward higher secondary bleeding and postoperative intake difficulties. Technique selection should prioritize postoperative comfort and morbidity reduction—particularly in pediatric populations—favoring cold dissection, with ligation offering a consistent analgesic advantage. Full article

Background and Objectives: Although cyanoacrylate–polylactic acid (CA + PLA) patches shorten the time to hemostasis after partial hepatectomy, their long-term biocompatibility remains uncertain. We compared the 5-month histopathological footprint of a novel CA + PLA patch (Study group) with a licensed fibrinogen/thrombin matrix (TachoSil^® group) and electrocautery (Control group). Methods: Thirty-three male Wistar rats underwent a 3 × 1.5 cm hepatic segment resection and were randomized to the Control (n = 5), Study (n = 14), or TachoSil^® (n = 14) group. The animals were sacrificed on postoperative day (POD) 50, 100, or 150. Blinded semiquantitative scoring (0–3) was used to capture inflammation intensity, and the number of neutrophils (PMNs), lymphocytes (Ly’s), isolated histiocytes, and foreign-body giant cells (FBGCs). Results: The proportions of animals in each group across the different sacrifice time points were homogeneous (χ² = 4.34, p = 0.36). The median inflammation remained mild (2 [IQR 1–2]) in the Control and Study groups but lower in the TachoSil^® group (1 [1–2], p = 0.47). The FBGC scores differed markedly (score ≥ 2: 64% in Study, 0% in Control, 14% in TachoSil^®; p < 0.001). Fibrosis occurred almost exclusively in the Study group (79% vs. 0%; χ² = 22.4, p < 0.001). Mature vessels were most frequently observed in the TachoSil^® group (50%, aOR = 5.1 vs. Study, p = 0.04). Abscesses only developed in the Study group (29%, p = 0.046). Within the TachoSil^® group, inflammation (ρ = −0.62, p = 0.019) and Ly infiltration (ρ = −0.76, p = 0.002) declined with time; no significant temporal trends emerged in the Study group. Conclusions: At the five-month follow-up, there was an exuberant foreign-body reaction, dense collagen deposition, and a higher abscess rate around the CA + PLA patch compared with both TachoSil^® and cautery. Conversely, TachoSil^® evolved toward a mature, well-vascularized scar with waning inflammation. These findings underscore the importance of chronic-phase evaluation before clinical adoption of new hemostatic biomaterials. Full article

Use of pair housing for preweaning calves has shown positive benefits in terms of health and production, with it also being thought to offer social support in times of stress such as when calves are disbudded. Calf disbudding through thermal cautery is a common procedure, with recognized physiological and behavioral implications. This study’s objective was to utilize continuous monitoring accelerometers to compare the impact of disbudding on the behavior of pair and individually housed calves. Data from an all-year-round dairy herd in the southwest of England were collected via an accelerometer (ABS breeder tag, Genus, Cheshire, UK) fitted to a forelimb of a convenience subset of calves (n = 265) within two weeks of age. Data were collected between March and December 2020 and covered the period 7 days prior to disbudding until 30 days post disbudding. Calves underwent thermal cautery disbudding by farm staff using local anesthesia and a systemic nonsteroidal anti-inflammatory drug. Data from 205 calves (125 pair-housed and 80 individually housed) were included in analysis through generalized estimating equations models. The calf activity (p = 0.98), number of lying bouts (p = 0.40), and lying time per day (p = 0.75) were not associated with the housing treatment of the calves. Calf activity was associated with the day compared to disbudding (p < 0.001), with both housing treatments having decreased activity in the days following disbudding, taking approximately 14 days to return to pretreatment levels. Full article

Cautery disbudding is a painful procedure and major welfare concern in organic dairy production, which lacks effective and easily implemented methods of pain control. Willow bark (WB) has been used to treat chronic pain in humans, but there is no scientific evidence that WB has an analgesic effect in dairy cattle. The objective of this study was to evaluate the effect of an oral WB bolus on heart rate, salivary cortisol concentration, ocular temperature, and lying behavior (time, bouts, and bout duration) of 42 Holstein and crossbred calves. Heifer calves were born at the University of Minnesota West Central Research and Outreach Center, Morris, MN organic dairy. Calves were disbudded from 4 to 7 weeks of age (42 ± 3 d) and randomly assigned to one of three treatments (n = 14 calves/treatment): hot iron disbudding with lidocaine (LID; 5 mL per horn bud), hot iron disbudding with oral WB (200 mg/kg), or sham disbudding (SD). Saliva samples and thermal images were collected 1 h before disbudding, at disbudding, and 5 min, 10 min, and every 30 min until 240 min after disbudding. Cardiac monitors recorded heart rates continuously throughout the 5 h study period. HOBO loggers recorded lying behavior during the 72 h following disbudding. The variables included in the statistical model for analyses were fixed effects of treatment, time, and the interaction between treatment and time, and calf was a random effect. The mean heart rate of LID calves (123.3 ± 2.8 beats/minute) and WB calves (124.5 ± 3.2 beats/minute) were higher than SD calves (110.8 ± 2.3 beats/minute). Salivary cortisol concentrations were higher for the LID calves (103.8 pg/mL) and for the WB calves (103.4 pg/mL) than for the SD calves (85.5 pg/mL). The ocular temperature was not affected by treatment group. There were fewer lying bouts 24 to 48 h after disbudding compared to the first 24 h after disbudding in both the LID and WB treatment groups. Treatment group did not affect lying time or lying bout duration. Neither LID nor WB alleviated the pain of calves throughout the post-disbudding period. The results highlighted the need to discover suitable options for pain mitigation of calves in organic livestock production. Full article

Epistaxis, commonly referred to as nosebleeds, is a frequent clinical presentation with etiologies spanning from localized trauma to systemic conditions and medication effects. Despite its high prevalence, management approaches vary significantly depending on the cause and severity. To provide a comprehensive review of current management strategies for epistaxis, focusing on initial interventions, evaluation techniques, and preventive measures. A structured review of the literature was conducted to identify effective strategies for the initial management, evaluation, and prevention of epistaxis. Emphasis was placed on practical applications for clinicians in both emergency and outpatient settings. Initial Management: Direct pressure and topical vasoconstrictors remain the first-line interventions. Persistent cases may require nasal packing or cautery. Evaluation: Identification of underlying causes such as hypertension, coagulopathies, and structural nasal abnormalities is crucial, particularly in recurrent or severe cases. Laboratory tests and imaging may aid in diagnosis and management planning. Prevention: Patient education on nasal hygiene, avoidance of nasal trauma, and maintenance of a humidified environment are critical in reducing recurrence. Integrating effective initial management with thorough evaluation and preventive strategies significantly improves patient outcomes. Full article

Background: Lumen-apposing metal stents (LAMS) are utilized in a wide range of therapeutic gastrointestinal applications. We present our experience with LAMS-assisted drainage of complex pelvic abscesses at a large safety-net hospital. Methods: EUS-guided LAMS placements for pelvic abscesses from July 2020 to June 2024 were analyzed. Data were collected on patient demographics, procedure indications, fluid collection size, stent characteristics, stent dwell time, and complications. All cases underwent multidisciplinary review with Surgery and Interventional Radiology (IR) prior to LAMS-assisted drainage; all were deemed not amenable to drainage by IR. Results: Eleven patients underwent EUS-guided drainage of complex pelvic abscesses with cautery-enhanced LAMS. Diverticulitis was the most common cause of abscesses (n = 6; 55%). The average time from presentation to drainage was 7 days (1–18). The average abscess size was 7.2 cm (3.9–12.0 cm). The most common LAMS size was 15 mm × 10 mm; each was placed through the left colon and rectum with both technical and clinical success. All abscesses completely resolved with a mean stent dwell time of 28 days (17–42 days). After stent removal, the fistula was not routinely closed. No complications such as stent migration, bleeding, or perforation occurred. There were no recurrences and no patients required additional surgical or IR procedures with a mean follow-up of 25 weeks (SD 35.6). Conclusions: Adequate drainage is the cornerstone of pelvic abscess management, but IR or surgical access can be challenging, with inadequate drainage and prolonged hospitalization leading to significant morbidity. In our experience, EUS-guided, LAMS-assisted drainage provides a safe and effective alternative for managing pelvic abscesses. Full article

The process of disbudding female calves is a common procedure in many dairy farms, avoiding injuries caused by horns and reducing feed bunk space requirements. The most common method for disbudding calves is by the use of a cautery iron, responsible for destroying the horn-generating tissue. After the procedure, wounds may be treated with an antibiotic-based spray. Nowadays, antimicrobial resistance is a worldwide concern in both human and veterinary medicine, highlighting the need to invest in the monitoring of antimicrobial use and in the development of alternative treatments in favour of One Health. The goal of this study is to promote a reduction in the use of antibiotics in farm animals by investigating an alternative treatment for disbudding wounds. Bepanthene^® (dexpanthenol, a derivative of pantothenic acid, a component of the B vitamin complex) is a plausible option, since it is widely used in human medicine for the treatment of skin irritations and burns. The comparison of the healing process of disbudding wounds treated with Bepanthene^® or a chlortetracycline-based spray was achieved through the presentation of a randomly-ordered sequence of images of the lesions to a panel of convenience-selected and blinded-to-treatment evaluators, composed of seven veterinarian practitioners, five veterinary medicine students, and five human medical field nurses. In order to classify the lesions, the panel applied an adapted format of a validated healing scale (Bates–Jensen Wound Assessment Tool), incorporating seven parameters of evaluation, culminating in the values used for statistical analyses. In the practitioners’ evaluation, a statistically significant effect for the factors of time and treatment in favour of Bepanthene^® was found for the parameters “Edges”, “Necrotic Tissue Type”, and “Skin Colour Surrounding Wound”, indicating that Bepanthene^® is superior to the spray when considering these parameters of healing. The assessment by the veterinary students showed a significant effect for the factors of time and treatment for the parameters “Necrotic Tissue Type”, in favour of the Bepanthene^®, and “Granulation Tissue”, in favour of the antibiotic spray, demonstrating no clear benefit for either treatment. Lastly, the evaluation performed by nurses showed a significant effect for the factors of time and treatment, in favour of the Bepanthene^®, for the parameters “Necrotic Tissue Type” and “Skin Colour Surrounding Wound”, leading to the conclusion that Bepanthene^® is associated with better and faster healing when compared to the spray. Overall, these findings lead us to suggest that Bepanthene^® presents a better healing index compared to a chlortetracycline-based spray, allowing it to be safely used as a substitute to an antimicrobial agent. Full article

Background: Conjunctival chemosis, a complication of lower blepharoplasty, can cause persistent discomfort and functional disturbances with worsening in the postoperative period following surgery. Methods: A review of the records of the lower blepharoplasty procedures carried out at the Humanitas Research Hospital, Rozzano, Milan, Italy was performed. Patients were categorized into two groups depending on the procedure performed: (1) transconjunctival blepharoplasty with the removal of the fatty lodges with canthopexy and (2) transcutaneous blepharoplasty with the removal of the fatty lodges with lateral canthoplasty. Each group was further divided into two more groups based on the surgical method used, that is either (a) cold blade and disposable cautery or (b) radiofrequency cut and coagulation and colorado tip (respectively 1a, 1b, 2a and 2b). All patients underwent a postoperative follow-up up to 24 months, which included an evaluation of cosmetic appearance, eyelid scarring and the severity of chemosis. The aim of the study was to investigate which of the surgical procedures causes a lower incidence of persistent type 3 conjunctival chemosis. Results: A total of 1047 patients who underwent lower lid blepharoplasty were included in the study. A total of 512 patients underwent transcutaneous blepharoplasty and 535 underwent the transconjunctival procedure. Among the first group of patients, 266 belong to group 1a and 246 to group 1b. In the second group, 264 were categorized as group 2a and 271 as group 2b. The incidence of type 3 chemosis in the transcutaneous blepharoplasty procedure with lateral canthoplasty was statistically significantly higher than in the transconjunctival approach, considering both the cold blade and the radiofrequency (p = 0.012, 0.010, 0.006, 0.004, respectively). Conclusions: A higher incidence of persistent type 3 conjunctival chemosis is associated with lateral canthus surgery and with the use of radiofrequency. Full article

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. Full article

Although endoscopic necrosectomy (EN) is a less invasive therapy for walled-off necrosis (WON), arterial bleeding can occur during EN. A 60-year-old man with infected WON underwent the EN procedure. During EN, the artery in the WON cavity was injured. As the artery was directly visible, we grasped it using a Coagrasper and coagulated the bleeding point. However, the bleeding was aggravated after coagulation owing to an extension of the vessel damage. The entire vessel was grasped, and complete hemostasis was achieved. The Coagrasper is useful for managing arterial bleeding; however, it should be employed only on the basis of its characteristics and in suitable scenarios. Full article

The development of materials that effectively stop bleeding and prevent wound adhesion is essential in both military and medical fields. However, traditional hemostasis methods, such as cautery, tourniquets, and gauze, have limitations. In recent years, new nanomaterials have gained popularity in medical and health fields due to their unique microstructural advantages. Compared to traditional materials, nanomaterials offer better adhesion, versatility, and improved bioavailability of traditional medicines. Nanomaterials also possess advantages such as a high degree and stability, self-degradation, fewer side effects, and improved wound healing, which make them ideal for the development of new hemostatic materials. Our review provides an overview of the currently used hemostatic strategies and materials, followed by a review of the cutting-edge nanomaterials for hemostasis, including nanoparticles and nanocomposite hydrogels. The paper also briefly describes the challenges faced by the application of nanomaterials for hemostasis and the prospects for their future development. Full article

Disbudding calves using hot iron cautery is a routine management procedure to destroy the germinal cells around the horn bud in calves. It is recommended that NSAIDs are used in conjunction with local anaesthesia to reduce pain in calves during and after the procedure. In this study, two treatment groups were examined; calves in the positive control MEL group received subcutaneous meloxicam, and SAL calves received sodium salicylate orally for three days, both in addition to a local anaesthesia. Tri-axis accelerometers were attached to the calves, and DLWG (Daily Live Weight Gain) was measured. There was no significant difference between the treatment groups with regard to DLWG (p = 0.52), MI (motion index (p = 0.66)), lying bouts (p = 0.96) or lying times (p = 0.54). Given these findings, sodium salicylate may offer a lower-cost option for farmers when given at licensed doses compared to meloxicam, as well as providing a reduced-stress method of NSAID administration via an oral route. In addition, this study identified significant differences in activity in the time periods before and after disbudding, with MI (p < 0.01), lying bouts (p = 0.002) and lying times (p < 0.001) indicating changes in behaviour which extended to five days post disbudding. Full article