Search Results (72)

Background: Adhesive capsulitis (AC) causes a global limitation of both active and passive range of motion (ROM) in the shoulder, with or without pain, and no specific radiographic findings. Its course is self-limiting and progresses through three or four stages. The diagnosis is primarily clinical, since imaging tests are nonspecific. Treatment options include physical therapy (PT), intra-articular corticosteroid injections, suprascapular nerve block (SSNB), and hydrodilatation (HD). The latter is useful for expanding and reducing inflammation of the joint capsule through the insufflation of saline solution, anesthetics, and corticosteroids. Objectives: To compare whether patients with AC, stratified by phase 1 and 2, who receive high-volume HD as treatment achieve better outcomes in terms of shoulder pain and function compared to patients who receive low-volume HD. To compare whether there are differences in PT times and to determine mean axillary recess (AR) values. Methods: A randomized, parallel-block, triple-blind clinical trial will be conducted in 64 patients with AC in phases 1 and 2, aged 30 to 70 years, with limited active and passive ROM in two planes, and shoulder pain lasting more than 3 months. HD will be administered with volumes of 20 mL or 40 mL, followed by a conventional rehabilitation program. Outcomes will be reviewed at the 1st, 3rd, and 6th months of HD. Variables collected will include Shoulder Pain and Disability Index (SPADI), Visual Analog Scale (VAS), Range of motion (ROM), Lattinen index (LI), AR size, and time to completion of PT. Results: HD has been gaining clinical relevance in interventional rehabilitation as a treatment for AC, although its medium- and long-term efficacy remains a matter of debate. The variability in the volumes used for capsular expansion, with studies ranging from 18 mL to 47 mL, is compounded by the fact that most of these studies do not differentiate between AC stages. This could influence treatment effectiveness. Furthermore, diagnosis remains a challenge since valid and specific diagnostic parameters are lacking. Conclusions: Understanding the differences between HD techniques, considering the influence of certain factors such as the volume used or the stages of AC, as well as improving diagnosis and the coordination of scientific work. This could facilitate the development of protocols for the use of HD in AC. Full article

Background: Peritoneal stretching from CO₂ insufflation is a primary mechanism of pain associated with laparoscopy. Cyclooxygenase-2 inhibitors are promising anti-inflammatory and analgesic agents. This study aimed to evaluate the effect of celecoxib on postoperative pain reduction and associated changes in peritoneal gene expression after laparoendoscopic single-site (LESS) surgery for benign gynecologic disease. Methods: In this randomized, double-blind, placebo-controlled pilot study, 70 patients were randomly assigned to receive either celecoxib or placebo (400 mg) 40 min before surgery. Peritoneal tissues were collected before and after CO₂ insufflation. We analyzed changes in expressions of prostaglandin I₂ synthase, prostaglandin E synthase (PTGES), PTGES3, aldo-keto reductase family 1 member C1, and 15-hydroxyprostaglandin dehydrogenase (HPGD). Numeric Rating Scale (NRS) pain scores were also compared between groups. Results: A total of 62 patients completed the study: 30 in the celecoxib group and 32 in the placebo group. The mean CO₂ exposure time was 60.4 min. In a quantitative real-time polymerase chain reaction analysis, HPGD mRNA expression significantly increased after surgery in patients exposed to CO₂ for more than 60 min. Patients treated with celecoxib showed a significantly higher rate of grade 3 expression (83.3% vs. 37.5%; p = 0.01) and a level 2 increase in HPGD expression on in situ hybridization (58.3% vs. 12.5%; p = 0.01), despite no significant difference on immunohistochemistry. Moreover, celecoxib effectively reduced NRS pain scores compared to placebo. Conclusions: In this pilot study, celecoxib appeared to reduce postoperative pain and was associated with increased HPGD mRNA expression in the peritoneal tissue of patients with prolonged CO₂ exposure during LESS surgery. These exploratory findings warrant confirmation in larger trials with functional validation of HPGD expression (ClinicalTrials.gov, NCT03391570). Full article

Objective: To explore the impact of supine retroperitoneal single-port robot-assisted partial nephrectomy with lower anterior access on perioperative ventilatory, cardiovascular, and pain-related outcomes compared to a cohort of patients treated with single-port robot-assisted retroperitoneal or transperitoneal partial nephrectomy with standard flank patient positioning. Materials and Methods: Clinical and surgical data of all consecutive patients treated with single-port robot-assisted partial nephrectomy between March 2019 and January 2024 were prospectively collected and retrospectively analyzed. Specific same-day-discharge guidelines were applied to all cases. Failed same-day discharge was defined as the presence of early (<90 days) perioperative complications or the absence of opioid-free postoperative recovery. Results: Overall, 105 consecutive patients treated with single-port robot-assisted partial nephrectomy were analyzed. No differences emerged in baseline features. Peak inspiratory pressure and plateau pressure changes were significantly lower in the supine retroperitoneal lower anterior access group from the time of CO₂ insufflation throughout every 30-min operative setpoint assessment (p = 0.02, p = 0.03, and p = 0.02, respectively). The transperitoneal group showed significantly higher values of mean, systolic, and diastolic blood pressure compared to retroperitoneal approaches. The supine lower anterior access group also showed significantly lower non-surgical operative room time, perioperative opioid administration, and postoperative median VAS pain score. Conclusions: The adoption of supine lower anterior access improved perioperative ventilatory, cardiovascular, and pain-related outcomes, also optimizing operating room efficiency. Further multicenter series with longer follow-ups are still needed to validate our preliminary results. Full article

Background: CT image guidance and navigation, although routinely used in complex endovascular procedures, is an unexplored territory in evolving vascular robotic procedures. In robotic surgery, it promises the better localization of vasculature, the optimization of port placement, less inadvertent tissue damage, and increased patient safety during the dissection of retroperitoneal structures. However, unknown tissue displacement resulting from induced pneumoperitoneum and positional changes compared to the preoperative CT scan can pose significant limitations to the reliability of image guidance. We aimed to study the displacement of retroperitoneal organs and vasculature due to factors such as increased intra-abdominal pressure (IAP) due to CO₂ insufflation and patient positioning (PP) using intraoperative CT imaging in a cadaveric model. Methods: A thawed, fresh-frozen human cadaveric model was positioned according to simulated procedural workflows. Intra-arterial, contrast-enhanced CT scans were performed after the insertion of four laparoscopic ports in the abdomen. CT scans were performed with 0–5–15–25 mmHg IAPs in supine, left lateral decubitus, right lateral decubitus, Trendelenburg, and reverse Trendelenburg positions. Euclidean distances between fixed anatomical bony and retroperitoneal vascular landmarks were measured and compared across different CT scans. Results: Comparing the effects of various IAPs to the baseline (zero IAP) in the same PP, an average displacement for retroperitoneal vascular landmarks ranged from 0.6 to 3.0 mm (SD 1.0–2.8 mm). When changing the PPs while maintaining the same IAP, the average displacement of the retroperitoneal vasculature ranged from 2.0 to 15.0 mm (SD 1.7–7.2 mm). Conclusions: Our preliminary imaging findings from a single cadaveric model suggest minimal (~3 mm maximum) target vasculature displacement in the retroperitoneum due to elevated IAP in supine position and higher displacement due to changes in patient positioning. Similar imaging studies are needed to quantify procedural workflow-specific and anatomy-specific deformation, which would be invaluable in developing and validating advanced tissue deformation models, facilitating the routine applicability and usefulness of CT image guidance for target delineation during robotic vascular procedures. Full article

Background: Synthetic cathinones (SCs) are the second most representative class of New Psychoactive Substances, with more than 100 analogues identified in the illicit drug market up to 2024. According to the United Nations Office on Drugs and Crimes, N-ethylhexedrone (NEH) and N-ethyl-nor-pentedrone (NEP) were identified among the most frequently seized SCs worldwide. However, still, little is known with regard to their pharmacological effects in humans. Methods: For the first time, we conducted a naturalistic, prospective observational study in 16 participants (7 women and 9 men) with a previous history of psychostimulant recreational use. They intranasally self-administered a single dose of NEP (n = 8, 20–40 mg) or NEH (n = 8, 20–40 mg). The physiological effects (systolic and diastolic blood pressure, heart rate, and temperature) and subjective effects (visual analogue scales, Addiction Research Center Inventory questionnaire and Evaluation of Subjective Effects of Substances with Abuse Potential questionnaire) were assessed up to 4 h after the self-administration at different time points (0, 20 and 40 min and 1, 1.5, 2, 3 and 4 h). Results: Despite several differences, both NEP and NEH produced significant effects within 20 min, with a return to baseline 3–4 h after self-administration. In general, NEP showed a faster onset and a more rapid disappearance of subjective effects than NEH. Moreover, intranasal self-administration of NEH and NEP in experienced recreational drug users, within a non-controlled setting, induces a constellation of psychostimulant-like effects. Conclusion: NEH and NEP showed similar pharmacological properties after insufflation, with typical effects of SCs Full article

Background/Objectives: Insufflation of the gastrointestinal tract, as a side effect of improper ventilation, is a known complication in resuscitation patients. As animal studies have shown, this can be associated with an increase in intra-abdominal pressure with adverse effects on hemodynamics and respiratory mechanics. In this study, we investigated the prevalence and severity of insufflation and discussed the potential impact on the outcome of resuscitation. Methods: This study was based on computed tomography (CT) images from two university hospitals in Munich, Germany, which were taken as part of the trauma room care of out-of-hospital cardiac arrest (OHCA) patients. According to local resuscitation protocol, CT performed during ongoing cardiopulmonary resuscitation or after the return of spontaneous circulation (ROSC) was archived to determine the potentially reversible cause of cardiac arrest. CT images from 2014 to 2018 were analyzed in this study. Using an advanced visualization and analysis platform for medical image data, the gas volume within the gastrointestinal tract was determined and compared between resuscitations with lethal and secondary survival outcomes. Results: A total of 92.44% of included OHCA patients (n = 172) showed signs of increased gastrointestinal gas volume in comparison to the physiologically prevalent gas volume. In OHCA patients with a lethal outcome, significantly more gas was detected in the gastrointestinal tract with a median of 757.40 mL compared to 380.65 mL in resuscitations with secondary survival (p ≤ 0.05; W = 4278). Furthermore, Cohen’s r was used to calculate the effect size, indicating a weak association with the outcome of resuscitation (r = 0.24). In addition, a logistic regression analysis was performed to examine the influence of age, gender (female), and the gas volume of the intestines and stomach on the dependent variable “death”. The analysis shows that the model, as a whole, is significant (Chi² = 17.67; p 0.02; n = 172) and supports the hypothesis that intestinal insufflation correlates with a lethal outcome from resuscitation (b = 0.001; OR 1.001 (95% CI [1.000–1.002]; p = 0.021). Conclusions: Insufflation in resuscitation patients is a common phenomenon with potential consequences for the outcome. Even if the effect we have shown appears small, the outcome of resuscitation patients can possibly be improved by preventing or correcting insufflation. To understand its potential impact on resuscitation outcomes fully, further work must be performed to investigate causality. Full article

Background: Increased intra-abdominal pressure (IAP), autonomic reactions, and anesthetics all contribute to hemodynamic alterations during laparoscopic cholecystectomy. This study’s objectives are to measure noninvasively the intraoperative individual responses in cardiac and systemic hemodynamics, focusing on cardiac output (CO. L/min), stroke volume (SV, mL/min), systemic vascular resistance (SVR, dyn.s.cm⁻⁵), and noninvasive mean arterial blood pressure (MABP, mmHg) during and after peritoneal insufflation (cmH₂O). The secondary objective was to evaluate the utility of EC as an adjunct to standard monitoring and to assess the individual differences. Methods: The CO and associated parameters were continuously and noninvasively monitored with the electrical cardiometry (EC, ICON, Osypka, Berlin Germany). Results: Seventy-three patients showed that when the IAP increased to 13 [IQR: 13-14] cmH₂O, there was an overall percentage decrease in CO (−11.29%), MABP (−9.31%), and SVR (−23.16%) compared to pre induction with minimal changes in heart rate (HR). Individual variation and extreme reactions among certain patients were noted, with CO falling by −47.14% and MABP by −61.59, respectively, which can have major repercussions. Conclusions: The EC enabled real-time, non-invasive CO monitoring and detected significant cardio-hemodynamic changes that conventional monitors could miss. EC can supplement traditional monitors and give attending anesthesiologists access to more of patients’ vital information. Full article

Background: Minimally invasive thoracic surgery has advanced since the introduction of multiportal video-assisted thoracoscopic surgery (mVATS) in 1991. Primary spontaneous pneumothorax (PSP) is an ideal condition for refining minimally invasive techniques owing to its straightforward procedures and predictable bullae distributions. Methods: Uniportal VATS (uVATS), which involves a single incision, is an alternative to mVATS, offering reduced postoperative pain, lower paresthesia rates, and comparable recurrence outcomes. This review explores two main uVATS approaches: intercostal and subxiphoid. Results: The intercostal approach is common to surgeons trained in mVATS, easier to adopt, and provides excellent cosmetic outcomes. Innovations such as the chest wall pulley method and anchoring sutures further enhance its operability and prevent recurrence. Subxiphoid uVATS minimizes intercostal nerve damage and postoperative pain, making it advantageous for bilateral PSP surgeries. However, it poses challenges such as longer operative times and limited dorsal visualization. Emerging strategies, including drainless postoperative management and two-lung ventilation with CO₂ insufflation, have reduced surgical invasiveness. Additionally, cosmetic techniques such as subaxillary incisions enhance patient satisfaction. Conclusions: uVATS continues to redefine PSP surgery, prioritize patient-centered outcomes, and integrate novel strategies to achieve superior results. Full article

Background/Objectives: Airstacking is a technique to improve lung compliance and maximum insufflation capacity (MIC) in patients with neuromuscular disorders by sequentially inflating the lungs using a manual resuscitation bag. Traditional methods lack standardization and rely on subjective feedback. A pilot study established optimal pressure ranges using a digital manometer, suggesting its potential to standardize airstacking. This study evaluates the longitudinal effects of airstacking with and without digital pressure feedback on pulmonary function. Methods: A stratified randomized controlled trial was conducted with 40 patients allocated into three groups: those performing airstacking appropriately (Group 1), those previously performing airstacking inappropriately but using digital pressure feedback during the study (Group 2), and those previously performing airstacking inappropriately without feedback (Group 3). Pulmonary function parameters, including forced vital capacity expressed as a percentage of the predicted normal value (FVC%), MIC, and assisted peak cough flow (aPCF), were measured at baseline, 3, 6, and 12 months. Caregiver outcomes, musculoskeletal pain, and satisfaction were assessed. Results: Digital pressure feedback did not significantly alter pulmonary function. Changes in FVC% (p = 0.164), MIC (p = 0.218) and aPCF (p = 0.787) were not statistically significant. However, Group 2 caregivers showed significant reductions in musculoskeletal pain than Group 3 (p = 0.036) and higher satisfaction (mean: 8.92/10). The proportion of caregivers achieving optimal pressure increased by 25% in Group 2 compared to 16.67% in Group 3. Conclusions: While digital pressure feedback did not significantly alter pulmonary function, it contributed to improved caregiver adherence and reduced musculoskeletal pain. These findings suggest that integrating objective pressure feedback into airstacking training may enhance technique standardization and caregiver experience, though its impact on pulmonary function remains uncertain. Full article

Background: O₃-O₂ therapy is an alternative medical treatment that introduces a mixture of O₃-O₂ into the body for therapeutic purposes. The objective of this study is to evaluate its margins of applicability in the eradication of HPV infection from the lower gynecological tract by means of vaginal insufflation. Methods: An in-depth review of the international literature on this topic is carried out; in addition, O₃-O₂ therapy is compared with other treatments currently available in terms of its advantages, disadvantages, and exploited technologies. Results: The possible benefits and limitations of O₃-O₂ vaginal insufflation are explained in detail; overall, it appears to be an interesting tool as part of complex management to prevent HPV-related cancers of the lower gynecological tract in infected patients. Conclusions: The rationale and guidelines of this innovative procedure have been successfully illustrated, providing the technical specifications for further developments. Full article

Background/Objectives: Children who suffer from congenital heart defects (CHDs) have a decreased ability to perform physical exercise and consequently have a decrease in their functional capacity. The main causes of this decrease in functional capacity have been related on the one hand to residual hemodynamic defects and, at the same time, to a situation of physical deconditioning due to inactivity, as well as problems in lung function, especially the presence of restrictive patterns that influence the amount of O₂ insufflated (decreased maximum VO₂), consequently generating a deficient maximum O₂ consumption and maximum work rate. This represents an important prognostic value, since it constitutes an independent predictor of death and hospitalization. This study aims to determine the benefits obtained regarding respiratory function, exercise capacity, and quality of life after implementing a hospital-based cardio-respiratory rehabilitation program compared to a home-based Cardio-respiratory Physical Activity Program in patients with intervened CHDs. Methods: This is a randomized controlled trial on the effectiveness of two different rehabilitation programs on respiratory function, exercise capacity, and quality of life in patients with CHDs conducted at the Child Cardiology and Congenital Heart Disease Unit of the University Hospital Complex of A Coruña (CHUAC). There will be two groups: Cardio-respiratory rehabilitation group program conducted in a face-to-face format at the hospital (n = 26) and a study group that follows a home-based Cardio-respiratory Physical Activity Program (TELEA) (n = 26). The measurement variables will be respiratory function, forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), maximum expiratory flow (PEF), the Tiffeneau index (FEV1 /FVC), forced expiratory flow (FEF25%, FEF50%, FEF75%, FEF25–75%), exercise capacity (peak VO₂), and the quality of life of these children and their families. Conclusions: The implementation of cardiac and pulmonary rehabilitation programs in children with CHDs is essential to improve their quality of life, exercise tolerance, and socialization. These programs optimize life expectancy and promote integration, being crucial for their physical and emotional well-being Full article

Promoting rapid healing is a concern in skin wound treatment, as the increased pain and the loss of functional ability when wounds become chronic create a complex problem to manage. This scoping review aimed to explore the literature and synthesize existing knowledge on the therapeutic use of CO₂ in treating cutaneous wounds. The literature was selected using previously defined inclusion and exclusion criteria, and 22 articles were selected for data extraction. The most researched type of injury was chronic wounds located on the extremities of the limbs. Carboxytherapy was performed in five different ways: subcutaneous, intradermal, or intralesional injections; in hot water baths with temperatures ranging from 30 to 42 °C; transcutaneous application; intra-abdominal insufflation; and a paste for transcutaneous local application. The main effects of CO₂ therapy described were as follows: improved blood flow and local oxygenation, reduction of the inflammatory process, increased collagen production, and improved clinical aspects of wounds, with faster healing. Carboxytherapy can be considered a good alternative for treating skin wounds, although further studies should be pursued to elucidate its molecular mechanisms and enhance its efficacy. Full article

The endoscopic resection of gastrointestinal tract lesions embraces different types of techniques, ranging from conventional polypectomy/endoscopic mucosal resection (EMR) to the field of third-space endoscopy, including endoscopic submucosal dissection (ESD), full-thickness resection and peroral endoscopic myotomy (POEM). Parallelly, the advent of underwater techniques has served as an add-on for both basic and advanced procedures, since its first report in 2012. We aimed to provide a comprehensive update on the state of the art about the feasibility of underwater basic and advanced techniques for GI endoscopy. Underwater EMR (U-EMR) has proved effective and safe in treating > 10 mm sessile or flat or all-size recurrent colonic lesions. Conversely, although data show good effectiveness and safety for <10 mm lesions, it is preferred when high-grade dysplasia is suspected, favouring cold snare polypectomy for all other cases. Moreover, promising data are emerging regarding the feasibility of U-ESD for difficult-to-resect colonic lesions. U-EMR represents a standard of care for treating < 25 mm superficial non-ampullary duodenal epithelial tumours. Data regarding oesophageal, gastric and ampullary lesions remains limited to small cohorts. Finally, using water immersion for POEM has shown a reduction in procedure time compared to the CO₂ insufflation technique for vessel coagulation, albeit in a single-centre experience. Based on these results, U-EMR has become a standard for treating intermediate-size colonic and non-ampullary duodenal lesions, as highlighted also in the European Society of Gastrointestinal Endoscopy guidelines. Promising results have been shown in third-space endoscopy studies, even though further prospective studies are awaited to standardise the technique for both ESD and POEM. Full article

Laparoscopic cholecystectomy is characterized by reduced postoperative pain, shorter hospital stays, rapid return to preoperative physical activity, and less psychological impact on the patient. During laparoscopic cholecystectomy, the intra-abdominal insufflation of carbon dioxide with secondary increase in intra-abdominal pressure can cause important hemodynamic consequences, like decreased cardiac output and blood pressure, as well as compensatory increase in heart rate. The purpose of this study is to evaluate changes in cardiovascular parameters during general anesthesia in patients undergoing laparoscopic cholecystectomy. Retrospective data from 342 patients with cholecystectomy for cholelithiasis performed at Railway Hospital Galati, Romania, were reviewed. All patients received the same intraoperative anesthetics. Female patients were 85.7% (n = 293). More than half of the patients, 53.51% (n = 183), were 40–59 years old, and only 16.37% (n = 56) were under 40 years old. Patients with a normal body mass index (BMI) represented 45.6% (n = 156), 33.3% (n = 114) were underweight, and 12% (n = 42) had grade 1 obesity (BMI 25–29.9 kg/m²). The minimum intraoperative blood pressure correlated with patient gender (p 0.015 < 0.005), with men having a higher blood pressure than women (p 0.006 < 0.05), and for BMI, a higher BMI was associated with elevated blood pressure (p 0.025 < 0.05). Older age correlated with an increased maximum intraoperative blood pressure (p < 0.001 < 0.05) and with maximum intraoperative heart rate (p 0.015 < 0.05). Patients undergoing laparoscopic cholecystectomy experienced significant hemodynamic changes with pneumoperitoneum, but this type of surgical intervention was safe for patients regardless of their age. Full article

(1) Objective: This study aimed to assess the evolution of the quality of ventilations of a group of rescuers after two training sessions by taking into account inspiration times. (2) Materials and Methods: A pilot simulation study was carried out with a sample of 10 lifeguard students. Two training sessions were held three weeks apart, in which CPR skills were trained by means of feedback tools. Participants performed three tests in pairs on a ResusciAnne QCPR^® manikin connected to SkillReporter QCPR software, namely one pre-training test and one test after each training session. CPR was performed in pairs for two minutes and began with five rescue breaths. (3) Results: One training session was enough to improve chest compression quality (T0: 48%; IQR 17–77/T1: 83%; IQR 59–88; p = 0.022/T2: 79%; IQR 64–92; p = 0.002). The quality of the ventilations increased progressively in each training session without reaching high-quality results (T0: 0%; IQR 0–0/T2: 15%; IQR 8–27; p = 0.011). (4) Conclusion: A two-session training program focused on inspiratory times achieved significant improvements in the quality of bag-mask ventilations performed by lifeguard students. Training focused on the insufflation time of ventilations and not only on the volume seems to be an important factor in improving the quality of ventilations. Full article