The safety and efficacy of fibrin sealant for thyroidectomy: a systematic review and meta-analysis of randomized controlled trials

Fibrin sealants have recently been thoroughly studied in several surgical specialties; however, results are conflicting. We aimed to examine the safety and efficacy of fibrin sealant patients having thyroidectomies. A thorough, systematic literature search was carried out using the terms thyroidectomy and fibrin sealant using PubMed, Cochrane Library, and Clinicaltrials.gov on December 25, 2022. The primary outcome of interest in this review was the amount of drainage, whereas hospitalization, the length of drain retention, and temporary dysphonia were secondary outcomes. Our meta-analysis (n = 249) showed that application of fibrin sealant is associated with lesser total drainage [SMD -2.76 (-4.83, -0.69); P = 0.009; I2 97%], but not with retention time of drainage [SMD -2.35 (-4.71, 0.01); P = 0.05; I2 98%], hospitalization time [SMD -1.65 (-3.70, 0.41); P = 0.12; I2 97%], and transient dysphonia [RR 1.01 (0.27, 3.82); P = 0.99; I2 0%]. The systematic review found that the use of fibrin sealant in thyroid surgery is positive in total volume drainage but not with the retention time of drainage, hospitalization time, and transient dysphonia. It is notable to remember that this interpretation is complicated by uneven, occasionally subpar technique and trial reporting, according to this systematic review's findings.

Utility of botulinum toxin injection for post-operative pain management after conventional hemorrhoidectomy: a systematic review and meta-analysis of clinical trials

BACKGROUND

Botulinum Toxin (BTX) has been found to have anti-spasm and analgesic effects. The utility of BTX after conventional hemorrhoidectomy remains unclear. Thus, a systematic review and meta-analysis are required to find out its utility after conventional hemorrhoidectomy.

METHODS

Using specific keywords, we comprehensively go through the potential articles on PubMed, ClinicalTrials.gov, and Europe PMC sources until March 27^th, 2022. All published studies on botulinum toxin anal sphincter injection after conventional hemorrhoidectomy were collected. We were using Review Manager 5.4 software to conduct statistical analysis.

RESULTS

Five clinical trial studies with a total of 260 patients undergoing hemorrhoidectomy were included in the analysis Our pooled analysis revealed that BTX injection after hemorrhoidectomy was associated with lower VAS at 24 h post-operative [Mean Difference -1.35 (95% CI -1.90, -0.80), p < 0.00001, I² = 0%] and shorter time to return work [Mean Difference -8.94 days (95% CI -12.57, -5.30), p < 0.00001, I² = 0%]. However, BTX injection did not differ significantly from placebo in terms of time to first defecation (p = 0.22), fecal incontinence (p = 0.91) and urinary retention incidence (p = 0.18).

CONCLUSION

BTX sphincter injection may offer some benefit after conventional hemorrhoidectomy in reducing pain from the first day after the procedure and promoting wound healing without complication. Further randomized clinical trials are still needed to confirm the results of our study.

Syringocystadenoma papilliferum in a 20-year-old adult: a case report and literature review

Syringocystadenoma papilliferum is a rare, benign hamartomatous neoplasm of skin adnexal originating from pluripotent cells differentiating into either apocrine or eccrine sweat glands. It usually appears at birth, during infancy or puberty and commonly located at head and neck. This case report illustrates a rare occurrence at an atypical anatomical location and unusual onset. In this case report, we report a 20-year-old female with a chief complain of solitary pink-brown color fleshy plaque with soft-medium consistency on her left flank region since the last 7 months. She underwent complete surgical excision and histopathology examination, which confirmed the diagnosis as syringocystadenoma papilliferum without sign of malignancy, with main characteristics histologically include cystic invaginations from the epidermis lined by double layers of epithelial and myoepithelial cells. Despite having benign characteristics, rare transformations to malignancy have been reported. Therefore, complete surgical excision and histopathology examination should be done in suspicion of syringocystadenoma papilliferum.

Orchioepididymitis Tuberculosis in Limited Setting: A Case Report and Brief Literature Review

BACKGROUND: Tuberculosis (TB) remains a major global health concern and highly prevalent in Indonesia. Extrapulmonary TB presents a diagnostic and therapeutic challenge. Clinically, orchioepididymitis TB of the scrotum often cannot be distinguished from lesions such as tumor and infarction, especially in apparently healthy patients. CASE REPORT: We present a rare case of unilateral orchioepididymitis TB which present as a testicular tumor resulted in the removal of the testis. CONCLUSION: The pathological finding revealed orchioepididymitis TB.

Retrieval of Intravascular Fractured Fragment of Tunnelled Double Lumen Catheter in Hemodialysis Patient

BACKGROUND:

Intravascular fractured fragment of double lumen catheter with embolisation is a serious and rare complication. Another serious complication includes infection, thrombosis, arrhythmias, and pulmonary embolism. We report a successful surgical venous cut-down technique in the retrieval of an intravascular fractured fragment of tunnelled double lumen catheter in a hemodialysis patient.

CASE REPORT:

A 51-year-old female underwent hemodialysis through a tunnelled double lumen catheter and had her arterio-venous graft matured. During retrieval of tunnelled double lumen catheter procedure, the distal part of the catheter was fractured and slipped into the internal jugular vein. Chest radiograph revealed intravascular double lumen catheter extending from the distal part of the right internal jugular vein to right atrium. The procedure of foreign body retrieval was done the next day under general anaesthesia and C-Arm guidance using right internal jugular venous cut-down approach. A right-angle clamp was used to retrieve the fragment without any post-procedure complications.

CONCLUSION:

Intravascular fractured fragment of double lumen catheter is a dangerous situation as are all the intravascular foreign bodies. The choices of the technique for retrieval of the fractured fragment are varied. It depends on the type and site of a fractured fragment as well as the surgeon experiences.