Elective Surgical Treatment Research Articles

Efficacy and Validity of Percutaneous Transhepatic Gallbladder Drainage as a Bridge to Surgery for Octogenarian and Older Patients With Acute Cholecystitis: A Single-Center Retrospective Observational Study in Japan.

Japan currently has a super-aged society, with a rapid increase in elderly patients in need of medical care. Determining treatment strategies for acute cholecystitis (AC) in very elderly patients with various comorbidities is often difficult. Although percutaneous cholecystostomy (PC) is a less-invasive treatment option, its impact on subsequent surgery remains debatable. This study investigated the validity of PC as a bridge to surgery in very elderly patients with AC. Of 215 patients who underwent cholecystectomy for AC at our hospital, we retrospectively investigated 83 patients aged ≥80 years-53 and 30 who underwent upfront surgery (US) and PC before surgery, respectively-to assess the treatment strategies and clinical course. The PC group had a significantly worse systemic status at diagnosis than the US group, including age, severity grading, comorbidities, performance status, systemic inflammatory status, and blood coagulation abnormalities, which improved after PC. The elective surgery rate was significantly higher in the PC group than in the US group. Despite the high number of severe cases in the PC group, surgical quality indicators, including the conversion rate to open surgery, operative time, blood loss, and critical view of safety achievement rate, tended to be better in the PC group, without severe perioperative complications. PC followed by cholecystectomy improves preoperative conditions, including systemic inflammation status and blood coagulation abnormalities, in very elderly patients, allowing safe elective surgical treatment while securing the quality of surgery and clinical outcomes.

Treatment options for patients with pilonidal sinus disease: PITSTOP, a mixed-methods evaluation.

There is no consensus on optimal management of pilonidal disease. Surgical practice is varied, and existing literature is mainly single-centre cohort studies of varied disease severity, interventions and outcome assessments. A prospective cohort study to determine: • disease severity and intervention relationship • most valued outcomes and treatment preference by patients • recommendations for policy and future research. Observational cohort study with nested mixed-methods case study. Discrete choice experiment. Clinician survey. Three-stage Delphi survey for patients and clinicians. Inter-rater reliability of classification system. Thirty-one National Health Service trusts. Patients aged > 16 years referred for elective surgical treatment of pilonidal disease. Surgery. Pain postoperative days 1 and 7, time to healing and return to normal activities, complications, recurrence. Outcomes compared between major and minor procedures using regression modelling, propensity score-based approaches and augmented inverse probability weighting to account for measured potential confounding features. Clinician survey: There was significant heterogeneity in surgeon practice preference. Limited training opportunities may impede efforts to improve practice. Cohort study: Over half of patients (60%; N = 667) had a major procedure. For these procedures, pain was greater on day 1 and day 7 (mean difference day 1 pain 1.58 points, 95% confidence interval 1.14 to 2.01 points, n = 536; mean difference day 7 pain 1.53 points, 95% confidence interval 1.12 to 1.95 points, n = 512). There were higher complication rates (adjusted risk difference 17.5%, 95% confidence interval 9.1 to 25.9%, n = 579), lower recurrence (adjusted risk difference -10.1%, 95% confidence interval -18.1 to -2.1%, n = 575), and longer time to healing (>34 days estimated difference) and time to return to normal activities (difference 25.9 days, 95% confidence interval 18.4 to 33.4 days). Mixed-methods analysis: Patient decision-making was influenced by prior experience of disease and anticipated recovery time. The burden involved in wound care and the gap between expected and actual time for recovery were the principal reasons given for decision regret. Discrete choice experiment: The strongest predictors of patient treatment choice were risk of infection/persistence (attribute importance 70%), and shorter recovery time (attribute importance 30%). Patients were willing to trade off these attributes. Those aged over 30 years had a higher risk tolerance (22.35-34.67%) for treatment failure if they could experience rapid recovery. There was no strong evidence that younger patients were willing to accept higher risk of treatment failure in exchange for a faster recovery. Patients were uniform in rejecting excision-and-leave-open because of the protracted nursing care it entailed. Wysocki classification analysis: There was acceptable inter-rater agreement (κ = 0.52, 95% confidence interval 0.42 to 0.61). Consensus exercise: Five research and practice priorities were identified. The top research priority was that a comparative trial should broadly group interventions. The top practice priority was that any interventions should be less disruptive than the disease itself. Incomplete recruitment and follow-up data were an issue, particularly given the multiple interventions. Assumptions were made regarding risk adjustment. Results suggest the burden of pilonidal surgery is greater than reported previously. This can be mitigated with better selection of intervention according to disease type and patient desired goals. Results indicate a framework for future higher-quality trials that stratify disease and utilise broad groupings of common interventions with development of a patient-centred core outcome set. This trial is registered as ISRCTN95551898. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 17/17/02) and is published in full in Health Technology Assessment; Vol. 28, No. 33. See the NIHR Funding and Awards website for further award information.

Improved rates of postoperative ischemia, completeness of aneurysm occlusion and neurological deficits in elective clipping of anterior circulation aneurysms over the past 20 years – association with technical improvements

Background/PurposeSeveral periprocedural adjuncts for elective surgical aneurysm treatment have been introduced over the last 20 years to increase safety and efficacy. Besides the introduction of IONM in the late-1990s, ICG-videoangiography (ICG-VAG) since the mid-2000s and intraoperative CT-angiography/-perfusion (iCT-A/-P) since the mid-2010s are available. We aimed to clarify whether the introduction of ICG-VAG and iCT-A/-P resulted in our department in a stepwise improvement in the rate of radiologically detected postoperative ischemia, complete aneurysm occlusion and postoperative new deficits.MethodsPatients undergoing microsurgical clip occlusion for unruptured anterior circulation aneurysms between 2000 and 2019 were included, with ICG-VAG since 2009 and iCT-A/-P (for selected cases) since 2016. Baseline characteristics and treatment-related morbidity/outcome focusing on differences between the three distinct cohorts (cohort-I: pre-ICG-VAG-era, cohort-II: ICG-VAG-era, cohort-III: ICG-VAG&iCT-A/-P-era) were analyzed.Results1391 patients were enrolled (n = 74 were excluded), 779 patients were interventionally treated, 538 patients were surgically clipped by a specialized vascular team (cohort-I n = 167, cohort-II n = 284, cohort-III n = 87). Aneurysm size was larger in cohort-I (8.9 vs. 7.5/6.8 mm; p < 0.01) without differences concerning age (mean:55years), gender distribution (m: f = 1:2.6) and aneurysm location (MCA:61%, ICA:18%, ACA/AcomA:21%). There was a stepwise improvement in the rate of radiologically detected postoperative ischemia (16.2vs.12.0vs.8.0%; p = 0.161), complete aneurysm occlusion (68.3vs.83.6vs.91.0%; p < 0.01) and postoperative new deficits (10.8vs.7.7vs.5.7%; p = 0.335) from cohort-I to -III. After a mean follow-up of 12months, a median modified Rankin scale of 0 was achieved in all cohorts.DiscussionAssociated with periprocedural technical achievements, surgical outcome in elective anterior circulation aneurysm surgery has improved in our service during the past 20 years.

Value of Flemish Version of the Triage Risk Screening Tool in Predicting Unfavorable Outcomes after Elective Cancer Surgery: A Propensity Score-Matched Retrospective Cohort Study

Introduction: The Flemish version of the Triage Risk Screening Tool (fTRST), derived from the Triage Risk Screening Tool for assessing risk of readmission to the emergency department, is increasingly used as a simple screening tool in oncology. This study aimed to evaluate the utility of the fTRST in the context of elective surgical treatment for urologic cancer patients. Methods: We included 886 patients who underwent major urologic cancer surgery at our institution between 2020 and 2022 and underwent preoperative screening, including fTRST. We set the fTRST cutoff at 2 and used propensity score matching and multivariate regression analysis to assess how fTRST affected two postoperative outcomes: ambulation failure and delirium. Results: Of the 886 patients, 693 (78%) had an fTRST score <2, and 193 (22%) had an fTRST score ≥2 (high likelihood of frailty). After matching the groups by propensity scores, we compared the outcomes of 131 patients in each group. We found that the group with fTRST ≥2 had significantly higher rates of ambulation failure (15 vs. 11%, p = 0.03) and delirium (16 vs. 11%, p = 0.008) than the group with fTRST <2. Multivariate logistic regression analysis showed that fTRST score ≥2 was an independent risk factor for postoperative ambulation failure (odds ratio [OR] = 4.05, p = 0.02), along with age ≥75 years (OR = 6.62, p = 0.02), preoperative benzodiazepine medications (OR = 5.12, p = 0.01), and receiving radical cystectomy (OR = 9.30, p = 0.02). Similarly, for delirium, fTRST score ≥2 was an independent risk factor (OR = 2.88, p = 0.03), along with preoperative benzodiazepine medications (OR = 4.38, p = 0.002). Conclusion: The fTRST might be a screening tool with great potential for identifying patients at high risk for unfavorable postoperative outcomes in elective urologic cancer surgery.

Manual reduction in testicular torsion and subsequent treatment after successful reduction: a series of reports in a single institution.

To explore the factors affecting the success of testicular torsion manual reduction and the safety of subsequent conservative treatment after successful reduction. Clinical data of 66 patients with testicular torsion treated in our emergency department from February 2017 to February 2022 were retrospectively collected. Manual reduction without anesthesia was performed in 19 patients. Patients with successful manual reduction chose different subsequent treatments according to the wishes of themselves and their guardians, including continuing conservative treatment and surgical exploration. Relevant clinical data were collected and analyzed. Manual reduction was successful in 11 patients (11/19). Seven of them chose to continue conservative treatment, and four underwent surgical exploration immediately. Among the 7 patients who were treated conservatively, 3 underwent surgical treatment due to scrotal discomfort or testicular torsion at different stages, and the remaining 4 patients showed no recurrence of torsion during follow-up. Compared with other patients, patients with successful manual reduction had the shorter duration of pain (p < 0.05). The time from visiting our hospital to surgery in patients who attempted manual reduction was slightly shorter than those who underwent surgery directly (p > 0.05). The testes of these 11 patients were all successfully preserved. The short duration of pain may contribute to the success of manual reduction, and manual reduction did not increase the preparation time before surgery. Due to the unpredictable risk of recurrence, immediate surgical treatment is still recommended, or postponed elective surgical treatment should be offered in the next days or weeks.

Clinical and pathogenetic justification for the use of therapeutic plasma exchange in the complex of preoperative preparation of patients with non-small cell lung cancer complicated by the inflammatory process

Purpose of the study. Determination of pathogenetic substantiation and indication criteria for the inclusion of extracorporeal detoxification methods in preoperative preparation of patients with non-small cell lung cancer (NSCLC) complicated by inflammation.Patients and methods. This study included the data on 222 patients with newly diagnosed stage I–IV NSCLC referred for elective surgical treatment to the Department of Thoracic Oncology, National Medical Centre for Oncology, in 2017–2019. Endogenous intoxication was evaluated in all patients depending on the leukogram results: leukocytic intoxication index (LII), body resistance index (BRI), reactive neutrophil response (RNR), and neutrophil-lymphocyte ratio (NLR). Indicators of the inflammatory response, i. e. interleukin 6 and procalcitonin, were also studied.Results. 36.5 % of NSCLC patients developed inflammation. That over 70 % of the NSCLC patients showed pronounced clinical and laboratory signs of endogenous intoxication and inhibited protective systems of homeostasis. Initial sub- or decompensated endotoxicosis together with reduced overall reactivity of the body poses a high risk of systemic inflammatory response to antitumor surgical treatment. This justifies the inclusion of extracorporeal detoxification into preoperative preparation of this category of patients as an active preoperative therapy.Conclusions. Simultaneous elevation of LII, RNR and NLR characterizing the presence of endotoxicosis in sub- and decompensation of endogenous intoxication by own physiological detoxification systems requires an active preoperative preparation with extracorporeal detoxification.

Abdominal compartment syndrome as a complication of endoscopic carbon dioxide insufflation in a patient with malignant bowel obstruction: a case report

BackgroundA self-expandable metal stent is often placed as a bridge to elective surgical treatment of left-sided malignant obstruction of the colon because it allows for primary anastomosis without the need for a temporary stoma, which has a positive impact on the patient’s quality of life. However, although a relatively safe procedure, colonic stenting can have complications that require emergency surgery. This case report describes a rare case of abdominal compartment syndrome that occurred as a complication of endoscopic insufflation during colonic stenting.Case presentationThe patient was a 72-year-old woman who presented complaining of several days of constipation and loss of appetite. Computed tomography of the abdomen revealed obstruction of the sigmoid colon by a tumor. There were no symptoms or computed tomography findings to suggest perforation. Therefore, an attempt was made to insert a self-expandable metal stent. Acute respiratory disturbance and a change in consciousness occurred during the stenting procedure, with marked abdominal distention. Abdominal compartment syndrome was diagnosed and treated by decompressive laparotomy.ConclusionsTo the best of our knowledge, this is the first reported case of abdominal compartment syndrome as a complication of endoscopic insufflation during colonic stenting. The possibility of abdominal compartment syndrome should be considered if acute respiratory disturbance or altered consciousness occurs during endoscopic procedure in a patient with malignant bowel obstruction.

Патогенетические особенности формирования несостоятельности тазового дна у женщин репродуктивного возраста

Background. Today, the issue of genital prolapse remains in the spotlight all over the world. This condition accounts for 30–40% of all cases of gynecological diseases. It should be noted that a third of women are women of child-bearing age. The problem of understanding true prevalence of pelvic organ prolapse (РОР) in various age groups is that there are no severe clinical symptoms during early stages of the disease, which ham-pers the diagnosis and, consequently, assessment of the prevalence of genital prolapse. That is why the prevalence of genital prolapse in women of child-bearing age has been little studied in the world literature. The other feature of the РОР diagnosis in young women is that it is difficult to verify pelvic floor dysfunction (PFD) before POP manifestation. Patients often do not seek medical care, since the complaints they present with are not typical for the concept of PFD. The patients’ complaints most often turn out to be related to abnormal vaginal biocenosis or even inflam-matory diseases of the pelvis, sexual dysfunctions. No treatment of such conditions results in abnormal anatomic and topographic interaction be-tween vaginal walls, reduced barrier function of introitus vaginae and altered vaginal microbiota composition, therefore, the woman suffers from recurrent pain that significantly reduces her quality of life. Aim. To study the perineal tissue state during the development of PFD. Methods. The prospective randomized comparative cohort study involved 155 women, who contacted the Department of Gynecology for elective surgical treatment. All patients underwent standard clinical and instrumental assessment for gynecological patients: history taking, physical ex-amination, advanced gynecological assessment, pelvic ultrasound. The assessment program was expanded to complex perineological examination including pelvic floor evaluation according to the method by L.R. Toktar, perineal manometry using the iEase XFT-0010 perineometer (according to the unit user manual), transperineal ultrasound. In addition, evaluation of vaginal biotope and morphological assessment of the levator com-plex were performed. Results. According to the data obtained, abnormal vaginal biotope is the major atypical PFD symptom. This condition is recurrent. The vaginal wall loss of elasticity and abnormal collagenization result in the more profound perineal tissue alterations. Morphological assessment of perineal tissues has revealed levator ani inflammation in 20% of cases and fibrosis in 100% of cases. Conclusions. Recurrent vaginal biocenosis abnormality is a clinical symptom of PFD. Vaginal dysbiosis results in morphological alterations in the vaginal wall structure and probably in the entire levator complex.

Neutrophil extracellular traps-associated markers in malignant neoplasms of the female reproductive system after surgical treatment and adjuvant chemotherapy

Introduction. Studies evidence about a relation between increased circulating free DNA (cfDNA) concentrations and chemotherapy, the majority of which have been focused on considering a tumor as a source of cfDNA. It has been suggested that neutrophils also contribute to this process, as cancer-related cfDNA characteristics resemble those of neutrophil extracellular traps (NETs). Therefore, the elevated concentration of cfDNA observed in chemotherapy patients may be associated with NETosis.Aim: assessment of NETosis markers in surgical treatment and adjuvant chemotherapy of patients with malignant neoplasms of the female reproductive system.Materials and Methods. A prospective non-randomized interventional controlled study was carried out by enrolling 111 patients with malignant breast diseases and female genital organs of various localizations and stages hospitalized for elective surgical treatment or chemotherapy course. The control group included 33 healthy women. 69 patients underwent surgical treatment. Adjuvant chemotherapy with paclitaxel and carboplatin was performed in 25 patients with ovarian cancer and 17 patients with breast cancer. In cancer patients, citrullinated histone H3 (citH3) and myeloperoxidase (MPO) were chosen as NETosis biomarkers allowing to distinguish NETs from other tumor-derived cfDNA thereby improving quality of research study. The concentration of NETosis markers was assessed before surgery or onset of chemotherapy upon admission to hospital and 14 days after surgery or 14 days after the second course of chemotherapy.Results. In all patients, the concentrations of NETosis markers before the start of therapy were significantly increased compared to the control group as well as 14 days after surgical treatment and 14 days after the second course of chemotherapy. However, in surgical patients, no significantly increased concentration of NETosis markers postvs. pre-surgery magnitude was observed. Upon that, patients underwent 2 courses of chemotherapy vs. baseline level were found to have significantly elevated magnitude of NETosis markers.Conclusion. The study revealed the relationship between administration of paclitaxel-containing chemotherapy in patients with ovarian cancer and breast cancer and a rise in NETs level. Chemotherapy is an essential component for management of patients with malignant neoplasms of the female reproductive system, therefore, development of new strategies to lower a risk of thrombosis and resistance to it is of crucial importance.

Analysis of Predictive Factors for the Poor Prognosis of Peripheral Facial Paralysis.

The aim of the study is to evaluate the predictive factors for a poor prognosis in patients with facial paralysis evaluated in the rehabilitation department of a tertiary hospital. We have conducted a prospective cohort study. Patients who required elective botulinum toxin infiltration, surgical treatment, or follow-up appointments longer than 6 months due to incomplete recovery were considered to have a poor prognosis. Descriptive and analytical analyses of clinical and epidemiological variables were performed. The follow-up period was 6 mos. A total of 47 adult patients were analyzed, 54.2% of whom were women. The mean age was 53.2 yrs (SD, 15.5 yrs). Twenty-five percent had an unfavorable prognosis. A statistically significant association with prognosis was observed for neurophysiological results and the scores of the House-Brackmann scale and the Sunnybrook Facial Grading System. Neurophysiological tests are especially useful when evaluating prognosis. Likewise, Sunnybrook Facial Grading System is a useful and accessible tool with prognostic value, especially within a month of initial diagnosis, when a score lower than 65 indicates a poor prognosis with high sensitivity and specificity. These tools can be especially useful to reduce the clinical and psychological impact and to provide patients with early therapeutic management.

Tool-tissue force segmentation and pattern recognition for evaluating neurosurgical performance

Surgical data quantification and comprehension expose subtle patterns in tasks and performance. Enabling surgical devices with artificial intelligence provides surgeons with personalized and objective performance evaluation: a virtual surgical assist. Here we present machine learning models developed for analyzing surgical finesse using tool-tissue interaction force data in surgical dissection obtained from a sensorized bipolar forceps. Data modeling was performed using 50 neurosurgery procedures that involved elective surgical treatment for various intracranial pathologies. The data collection was conducted by 13 surgeons of varying experience levels using sensorized bipolar forceps, SmartForceps System. The machine learning algorithm constituted design and implementation for three primary purposes, i.e., force profile segmentation for obtaining active periods of tool utilization using T-U-Net, surgical skill classification into Expert and Novice, and surgical task recognition into two primary categories of Coagulation versus non-Coagulation using FTFIT deep learning architectures. The final report to surgeon was a dashboard containing recognized segments of force application categorized into skill and task classes along with performance metrics charts compared to expert level surgeons. Operating room data recording of > 161 h containing approximately 3.6 K periods of tool operation was utilized. The modeling resulted in Weighted F1-score = 0.95 and AUC = 0.99 for force profile segmentation using T-U-Net, Weighted F1-score = 0.71 and AUC = 0.81 for surgical skill classification, and Weighted F1-score = 0.82 and AUC = 0.89 for surgical task recognition using a subset of hand-crafted features augmented to FTFIT neural network. This study delivers a novel machine learning module in a cloud, enabling an end-to-end platform for intraoperative surgical performance monitoring and evaluation. Accessed through a secure application for professional connectivity, a paradigm for data-driven learning is established.

Greater Saphenous Vein Aneurysm: Case Report

BACKGROUND: Venous aneurysms are rare vascular pathology. They were first described by Sir Wiliam Osler in 1915 and thereafter Harris in 1928. Aneurysm on greater saphenous vein is mostly asymptomatic or they are responsible for no more than local discomfort, pain, and tenderness and it is detected when patients were referred for the treatment or evaluation of a femoral or inguinal hernia or soft-tissue masses. CASE PRESENTATION: We presented a case of a 64-year-old man admitted to the hospital for elective surgical treatment of greater saphenous vein aneurysm. Computed tomography angiography showed an aneurysmatic change on the saphenous vein on the right lower leg with dimension of aneurismae 41 × 40 × 39 mm. After the diagnostic examination was finish, there was an indication for surgical treatment. The patient was successfully operated with non-postoperative complications. CONCLUSION: The indications for surgical treatment in superficial venous aneurysms are the presence of symptoms, the risk of thrombosis, compression of nearby structures, and more commonly esthetic problems. Surgical treatment is the treatment of choice for reducing the symptoms, risk of thrombosis, and esthetic problems and it has excellent results if there are not any other vascular pathologies.

The Challenge of Emerging Resistant Gram-Positive Pathogens in Hip and Knee Periprosthetic Joint Infections.

An increase in resistant bacterial pathogens has occurred over the last 4 decades. Careful patient selection and improving or correcting risk factors for periprosthetic joint infection (PJI) before elective surgical treatment are strongly recommended. Appropriate microbiological methods, including those used to detect and grow Cutibacterium acnes, are recommended. Antimicrobial agents used in the prevention or management of infection should be selected appropriately and the duration of therapy should be carefully considered in order to mitigate the risk of developing bacterial resistance. Molecular methods including rapid polymerase chain reaction (PCR) diagnostics, 16S sequencing, and/or shotgun and/or targeted whole-genome sequencing are recommended in culture-negative cases of PJI. Expert consultation with an infectious diseases specialist (if available) is recommended to assist with the appropriate antimicrobial management and monitoring of patients with PJI.

Which trial do we need? Elective early surgical treatment of left-sided infective endocarditis

Which trial do we need? Elective early surgical treatment of left-sided infective endocarditis

An impact of neutrophil extracellular traps to the prothrombotic state and tumor progression in gynecological cancer patients

Introduction. One of the leading causes in the mortality pattern of cancer patients is accounted for by thrombotic complications. Recent studies have shown that neutrophil extracellular traps (NETs) are involved in the activation of coagulation, contribute to the initiation and progression of thrombosis. In addition, NET-related effect on tumor progression and metastasis has been actively studied.Aim: to evaluate NET-related procoagulant activity in gynecological cancer patients.Materials and Methods. From April 2020 to October 2022, a prospective controlled interventional non-randomized study was conducted with 120 women. The main group included 87 patients aged 32 to 72 years with malignant neoplasms of the female genital organs and mammary glands who were hospitalized for elective surgical treatment or chemotherapy: uterine body cancer (subgroup 1; n = 18), ovarian cancer (subgroup 2; n = 26), cervical cancer – adenocarcinoma of the cervical canal (subgroup 3; n = 13), breast cancer (subgroup 4; n = 30). The control group consisted of 33 healthy women aged 32 to 68 years. In all women, plasma concentrations of citrullinated histone H3 (citH3), myeloperoxidase antigen (MPO:Ag), D-dimer, and thrombin–antithrombin (TAT) complexes were evaluated.Results. The magnitude of NETosis in cancer patients, assessed by level of citH3 (2.5 ± 0.7; 1.9 ± 0.8; 2.5 ± 0.7; 0.7 ± 0.5 ng/ml in four subgroups, respectively) and MPO:Ag (29.5 ± 13.1; 12.8 ± 3.7; 22.8 ± 8.7; 6.6 ± 2.5 ng/ml in four subgroups, respectively) was significantly higher compared to women in the control group (0.3 ± 0.1 ng/ml; p = 0.0001 and 2.5 ± 0.2 ng/ml; p = 0.0001). In parallel with increased NETosis markers in accordance with the disease stage, there was an increase in the concentration of hemostasis activation markers – D-dimer (1.7 ± 0.6; 2.0 ± 0.7; 1.4 ± 0.5; 1.5 ± 0.7 µg/ml in four subgroups, respectively) and TAT complexes (729.8 ± 43.9; 794.1 ± 164.8; 636.2 ± 149.5; 699.6 ± 165.7 pg/ml in four subgroups, respectively) exceeding their level in the control group (respectively, 0.4 ± 0.1 μg/ml; p = 0.0001 and 362.3 ± 0.1 pg/ml; p = 0.0001). The maximum values of parameters occurred at later stages according to the Classification of Malignant Tumours (tumor, nodus, metastasis, TNM). A significant correlation between TAT level and the concentrations of citH3 (r = 0.586; р = 0.04) and MPO:Ag was revealed (r = 0.631; р = 0.04).Conclusion. Tumor tissue creates milieu that stimulates NETs release, which, in turn, not only contribute to the creating a procoagulant state, but also might act as one of the factors that ensure tumor progression and metastasis. The development of targeted therapies acting on NETs has a potential to affect hemostasis in cancer patients and reduce rate of tumor growth and metastasis.

Фактор фон Виллебранда и ADAMTS13 как предикторы тромбоза у онкогинекологических пациенток на фоне химиотерапии

The incidence of venous thrombosis in patients undergoing chemotherapy is high. Activation of vascular endothelium during chemotherapy is followed by elevated concentrations of von Willebrand factor (vWF), decreased concentrations of ADAMTS13, and increased thrombotic risk. Objective. To study the significance of vWF:Ag and ADAMTS13:Ag concentrations and the ratio of vWF:Ag to ADAMTS13:Ag (VWF:Ag/ADAMTS13:Ag) as risk factors for thrombosis in gynecologic cancer patients undergoing chemotherapy. Patients and methods. The prospective controlled interventional non-randomized trial included 222 patients aged 34 to 72 years who underwent elective surgical treatment (138 patients) and chemotherapy courses (84 patients), and 50 healthy women in the control group. Concentrations of vWF:Ag and ADAMTS13:Ag, as well as markers of hemostatic activation such as thrombin-antithrombin complex (TAT) and D-dimer were determined in the patients’ plasma before therapy (baseline levels), 14 days after surgical treatment, and 14 days after 2 courses of chemotherapy. Results. Concentrations of vWF:Ag were significantly higher and concentrations of ADAMTS13:Ag were significantly lower among cancer patients both before and after surgical treatment and after chemotherapy compared to healthy controls. There was a significant difference in the dynamics of indicators in patients after chemotherapy compared to patients after surgical treatment. Significant changes in the vWF:Ag/ADAMTS13:Ag ratio between the groups of patients after surgical treatment and on the background of chemotherapy were also confirmed. A correlation was found between an increase in vWF:Ag concentrations, vWF:Ag/ADAMTS13:Ag ratio and TAT concentrations, and thus the risk of thrombosis. The study was conducted against the background of using standard thromboprophylaxis regimens in all patients, considering the high risk of thrombosis in all patients included in the study, according to standard thrombosis risk assessment scales. Conclusion. Concentrations of vWF:Ag, ADAMTS13:Ag and the vWF:Ag/ADAMTS13:Ag ratio can be considered as predictors of thrombosis during chemotherapy in gynecologic cancer patients. Key words: von Willebrand factor, ADAMTS13, cancer, chemotherapy

Ultrasound-guided modified pectoral plane (PECS II) block versus erector spinae plane (ESP) block for perioperative analgesia of surgical treatment of gynecomastia

BackgroundNerve block reduces anesthetics requirement, allows faster recovery, and reduces postoperative pain. The modified pectoral plane block (PECS II) and the erector spinae plane block (ESP) have been proposed for nerve block in men undergoing breast surgery for gynecomastia.This study aimed to compare the efficacy of PECS II and ESP for perioperative analgesia in men undergoing surgical treatment of gynecomastia.We conducted a randomized clinical trial on 46 males (with ASA I and II, age range from 18 to 25 years) undergoing surgical gynecomastia treatment in a tertiary medical center. Patients were randomly allocated to receive nerve blocks with either PECS II or ESP in addition to the general anesthesia. The postoperative opioid requirement, analgesic doses, pain intensity on the VAS score, hemodynamic parameters throughout the operation, and complications were recorded and compared for both groups.ResultsPECS II group had more favorable outcomes compared to the ESP group, evident by the significantly less total morphine consumption in 24 h (6.09 vs. 14.26 mg, P ≤ 0.001) and the significantly higher effective analgesic time (6.57 vs. 4.91 h, P ≤ 0.001). In addition, there were no intraoperative or postoperative complications recorded in both groups.ConclusionsFor men undergoing elective surgical treatment of gynecomastia, the ultrasound-guided modified PECS II is superior to the ESP in terms of opioid requirement, analgesic doses, and pain intensity.

CORR Insights®: Involvement in a Personal Injury Claim Is Associated With More Pain and Delayed Return to Work After Elective Nonsurgical or Surgical Treatment for Hand or Wrist Disorders: A Propensity Score-matched Comparative Study.

1Professor of Clinical Hand Surgery, Southern Illinois Hand Center, Southern Illinois University, Effingham, IL, USA N. H. Naam, 901 Medical Park Drive, Effingham, IL 62401, USA, Email: [email protected] This CORR Insights® is a commentary on the article “Involvement in a Personal Injury Claim is Associated with More Pain and Delayed Return to Work After Elective Nonsurgical or Surgical Treatment for Hand or Wrist Disorders: A Propensity Score–matched Comparative Study” by Hoogendam and colleagues available at: DOI: 10.1097/CORR.0000000000002410. The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®.

Does the healthcare system know what to cut under the pandemic emergency pressure? An observational study on geographic variation of surgical procedures in Italy

ObjectivesDuring 2020 many countries reduced the number of elective surgeries to free up beds and cope with the COVID-19 outbreak. This situation led healthcare systems to prioritise elective interventions and...

The Comparison of the Quality of Life and Complications in Segmental Colectomy and Subtotal Colectomy as the Treatment for Malignant the Left Colon Tumors

Background: This study was designed to compare postoperative complications, mortality and quality of life associated with the type of surgery (subtotal colectomy vs. segmental colectomy) in patients with left colon tumors. Subtotal colectomy and segmental colectomy are the two most common strategies used for treating the left colon’s malignant tumors. However, each patient’s optimal elective surgical treatment for the left colon’s malignant tumors is unclear. Choosing the optimal treatment for each patient, taking into account the individual conditions and preferences of the patients, with the least chance for occurrence of complications and the highest quality of life can help patients to ultimately return to everyday life. Methods: In this retrospective multi-centric study, patients with left colon tumors who had not received neoadjuvant and have undergone subtotal colectomy or segmental colectomy from 2016 to 2018 were enrolled. Mortality rate, quality of life and postoperative complications such as problems with defecation were assessed as the main outcome measures. Results: In patients with malignant tumors of left colon, both subtotal colectomy and segmental colectomy surgical methods reached the satisfactory results. In fact, there was no significant difference between the two surgical methods except that patients who had undergone subtotal colectomy showed better stool control capability. Conclusion: There was no significant difference between the two surgical procedures regarding postoperative complications and quality of life.