Patients In Surgical Group Research Articles

Outcome of Percutaneous Ultrasound Guided Aspiration versus Open Surgical Drainage of Psoas Muscle Abscess

Objective: To compare the outcome of percutaneous ultrasound guided aspiration V/S open surgical drainage for psoas muscle abscess.
 Methodology: This comparative study was conducted in department of general surgery at Liaquat medical university hospital Hyderabad/Jamshoro, from June 2017 to November 2017. Diagnosed Patients of psoas muscle abscess size more than 5cm, between 18 to 60 years of age and either of gender were included. Patients were randomly divided into two groups, A and B by odd and even method, patients in group A abscess was aspirated by percutaneous ultrasound guided aspiration and patients in group B was underwent open surgical drainage, all the data were entered in the pre designed performa and analyzed into SPSS V:16.0
 Results: A total of 58 patients of Psoas muscle abscess were selected, the mean age of study subjects of group A was 38.5+10.5 and group B was 36.5+12.7 (p-673). Early post-operative pain relief was assessed among patients of group A as compared to group B. As per outcome resolution of abscess cavity was significantly high among patients of group B (p-0.004), while post-operative Hospital stay was significantly lower in group A (p-0.002).
 Conclusion: Both techniques has their own benefits like percutaneous aspiration has shorter duration of hospital stay while in complete resolution of abscess cavity was found in open surgical drainage group of patients.

The effect of preemptive airway pressure release ventilation on patients with high risk for acute respiratory distress syndrome: a randomized controlled trial

Background and objectivesThe objective of this study was to investigate the use of early APRV mode as a lung protective strategy compared to conventional methods with regard to ARDS development. MethodsThe study was designed as a randomized, non-blinded, single-center, superiority trial with two parallel groups and a primary endpoint of ARDS development. Patients under invasive mechanical ventilation who were not diagnosed with ARDS and had Lung Injury Prediction Score greater than 7 were included in the study. The patients were assigned to APRV and P-SIMV + PS mode groups. ResultsPatients were treated with P-SIMV+PS or APRV mode; 33 (50.8%) and 32 (49.2%), respectively. The P/F ratio values were higher in the APRV group on day 3 (p = 0.032). The fraction of inspired oxygen value was lower in the APRV group at day 7 (p = 0.011).While 5 of the 33 patients (15.2%) in the P-SIMV+PS group developed ARDS, one out of the 32 patients (3.1%) in the APRV group developed ARDS during follow-up (p = 0.197). The groups didn’t differ in terms of vasopressor/inotrope requirement, successful extubation rates, and/or mortality rates (p = 1.000, p = 0.911, p = 0.705, respectively). Duration of intensive care unit stay was 8 (2–11) days in the APRV group and 13 (8–81) days in the P-SIMV+PS group (p = 0.019). ConclusionsThe APRV mode can be used safely in selected groups of surgical and medical patients while preserving spontaneous respiration to a make benefit of its lung-protective effects. In comparison to the conventional mode, it is associated with improved oxygenation, higher mean airway pressures, and shorter intensive care unit stay. However, it does not reduce the sedation requirement, ARDS development, or mortality.

Comparison of the Time to Extubation and Length of Stay in the PACU after Sugammadex and Neostigmine Use in Two Types of Surgery: A Monocentric Retrospective Analysis.

Sugammadex provides a rapid pharmacological reversal of aminosteroid, as well as fewer pulmonary complications, a better physiological recovery, and shorter stays in the postanesthetic recovery unit (PACU). This retrospective analysis of our Centricity anesthesia database in 2017–2019 assessed the efficiency of sugammadex in real-life situations in two groups of surgical cancer patients (breast and abdominal surgery) based on the extubation time, operating room exit time, and length of PACU stay. Overall, 382 anesthesia records (131 breast and 251 abdominal surgeries) were extracted for the pharmacological reversal of neuromuscular blockades by neostigmine or sugammadex. Sugammadex was used for reversal in 91 breast and 204 abdominal surgeries. Sugammadex use did not affect the extubation time, operating room exit time, or length of PACU stay. However, the time to reach a 90% train of four (TOF) recovery was significantly faster in sugammadex patients: 2 min (1.5–8) in breast surgery and 2 min (1.5–7) in abdominal surgery versus 10 (6–20) and 9 min (5–20), respectively, for neostigmine (p < 0.05). Most patients who were reversed with sugammadex (91%) reached a TOF ratio of at least 90%, while 54% of neostigmine patients had a 90% TOF ratio recorded (p < 0.05). Factors other than pharmacological reversal probably influence the extubation time, operating room exit time, or PACU stay; however, sugammadex reliably shortened the time so as to reach a 90% TOF ratio with a better level of reversal.

Novel Analgesic Index for Postoperative Pain Assessment Based on a Photoplethysmographic Spectrogram and Convolutional Neural Network: Observational Study.

BackgroundAlthough commercially available analgesic indices based on biosignal processing have been used to quantify nociception during general anesthesia, their performance is low in conscious patients. Therefore, there is a need to develop a new analgesic index with improved performance to quantify postoperative pain in conscious patients.ObjectiveThis study aimed to develop a new analgesic index using photoplethysmogram (PPG) spectrograms and a convolutional neural network (CNN) to objectively assess pain in conscious patients.MethodsPPGs were obtained from a group of surgical patients for 6 minutes both in the absence (preoperatively) and in the presence (postoperatively) of pain. Then, the PPG data of the latter 5 minutes were used for analysis. Based on the PPGs and a CNN, we developed a spectrogram–CNN index for pain assessment. The area under the curve (AUC) of the receiver-operating characteristic curve was measured to evaluate the performance of the 2 indices.ResultsPPGs from 100 patients were used to develop the spectrogram–CNN index. When there was pain, the mean (95% CI) spectrogram–CNN index value increased significantly—baseline: 28.5 (24.2-30.7) versus recovery area: 65.7 (60.5-68.3); P<.01. The AUC and balanced accuracy were 0.76 and 71.4%, respectively. The spectrogram–CNN index cutoff value for detecting pain was 48, with a sensitivity of 68.3% and specificity of 73.8%.ConclusionsAlthough there were limitations to the study design, we confirmed that the spectrogram–CNN index can efficiently detect postoperative pain in conscious patients. Further studies are required to assess the spectrogram–CNN index’s feasibility and prevent overfitting to various populations, including patients under general anesthesia.Trial RegistrationClinical Research Information Service KCT0002080; https://cris.nih.go.kr/cris/search/search_result_st01.jsp?seq=6638

First Indian Study on the use on the use of Indirect Calorimetry versus usual care in a tertiary care institute in India

Objective: To study the effect of Indirect calorimetry on the length of stay. The study comprises of the comparison between the use of indirect calorimetry versus usual care in critically ill mechanically ventilated patients with respect to the length of stay in the intensive care unit, and duration of time on ventilator. Patients were divided on basis of their nutrition risk to study the effect of Indirect calorimetry on the length of stay. Methods: This was a retrospective cohort study of 166 mechanical ventilated patients in S .L Raheja Hospital. Data was collected from 83 patients who were mechanically ventilated between January 2019 and November 2019 on whom indirect calorimetry was used to measure energy requirements. This cohort was compared to 83 patients between January 2018 and November 2918 where the energy requirements were calculated with the use of predictive equations. Both groups were matched for age, sex, comorbidities, Apache score and use of vasopressors. Results: Significant difference in the sicker group of patients was seen in the Length of stay in the intensive care unit. (9.23 +/- 8.14 vs 11.52 +/- 5.65, p value- 0.0034) Patients at risk for malnutrition demonstrated reduced length of time on ventilation as compared to those not at risk. (10.2 =/- 11.01 vs 13 +/-5.87,p value-0.0042) Conclusion: The use of indirect calorimetry may be associated with a lower length of icu stay among ventilated patients in a reasonably sick group of mixed surgical patients. KEY WORDS: indirect calorimetry; length of stay, mechanical ventilation

Conservative versus Surgical Treatment for the Fifth Metatarsal Diaphyseal Fractures: A Retrospective Comparative Study

Category:Midfoot/Forefoot; TraumaIntroduction/Purpose:The fifth metatarsal fracture is the most common metatarsal fracture accounting for 56-68% of all metatarsals. Most of the previous studies have focused on fractures of the proximal fifth metatarsal. Whereas the current evidence has still remained controversial regarding appropriate treatment for the fifth metatarsal diaphyseal fracture. To date, there has been no comparative study between nonsurgical and surgical management in such fractures. The purpose of this study was to compare the outcomes and complications following conservative versus surgical treatment for displaced diaphyseal fractures of the fifth metatarsal bone. The primary outcome was time to union. Secondary outcomes were functional outcome scores (SF-36 and FAAM), VAS, time to return to activities of daily living (ADL), sports activities as well as complications.Methods:A retrospective study with prospective outcomes measurement was performed by reviewing charts and collecting data between January 2016 and December 2018. We included patients aged 18 or over, diagnosed with closed isolated fracture of the fifth metatarsal diaphyseal bone, all fractures had more than 2 mm of displacement in any planes of radiographs (AP, oblique, lateral), treated within 3 weeks after injury, minimal follow-up time of 6 months. Exclusion criteria were previous history of ipsilateral fifth metatarsal diaphyseal bone, pathological or stress fracture, proximal fifth metatarsal fracture, underlying diabetes, neuropathy, inability to walk such as cerebrovascular disease. All patients in surgical group were treated with ORIF with plate and screws. Postoperatively, early ROM exercise and heel weight bearing in walking boot were instructed. Whereas, patients in conservative group were immobilized with short leg cast in first six weeks and subsequently changed to walking boot or hard- soled shoes.Results:There were forty-five patients enrolled in the study, twenty patients treated with ORIF and twenty-five patients treated with casting. No significant differences were demonstrated with regard to demographic data. The mean union time of ORIF group was 8.7+-1.8 weeks, which was significantly shorter than the casting group (16.0 +- 4.18 weeks) (p<0.001). There was a significant improvement of functional outcomes (SF-36, FAAM) in both groups (p<0.001) but no statistically significant difference between two groups (p>0.05). An average time to return to ADL was significantly faster in ORIF group (8.6+-3.1 weeks) (p<0.001). The overall complications in casting group were significantly higher (28%,p<0.05) including painful malunion (3 patients, 12%), delayed union (2 patients, 8%) and persistent pain from CRPS (2 patients, 8%).Conclusion:Both casting and ORIF demonstrated significant improvement of functional outcomes compared to pre-operative status as measured with VAS, SF-36, and FAAM. Even though there was no significant difference of functional outcomes between two groups. ORIF group had significantly faster union time, time to return to ADL, and lesser in overall complications. The authors prefer early surgical treatment in fractures with more than 2 mm displacement, active, high-demand patients. However, randomized controlled trials with longer follow-up would be required.

PREOPERATIVE SCREENING FOR OSA IN ELECTIVE SURGERY USING SYMPTOMLESS MULTI-VARIABLE APNEA PREDICTION INDEX AND STOP-BANG: A PILOT STUDY

SESSION TITLE: Sleep Disorders Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Obstructive Sleep Apnea (OSA) is highly prevalent and a risk factor for postoperative complications among elective surgery patients. Currently, the commonly utilized perioperative OSA-risk screening tool is the STOP-BANG questionnaire that consists of eight variables including symptom questions. The Symptomless Multi-Variable Apnea Prediction index (sMVAP), however, is a symptomless tool using three routinely collected variables, age, gender, and body mass index (BMI), to determine OSA-risk. The goal of this study was to evaluate the model performance of the sMVAP compared to the STOP-BANG and their association with OSA-risk and comorbidities in a cohort of elective surgery patients. METHODS: We conducted a retrospective chart review of adult elective surgery patients ≥ 18 years of age excluding obstetrics. The sMVAP and STOP-BANG scores were calculated. The sMVAP scores were then categorized into 5 quintiles. Inter-quintile analysis was performed to determine the relationship of sMVAP scores to a formal diagnosis of OSA, demographic data, and comorbidities. RESULTS: A total of 205 surgical patients were included. The sensitivity, specificity and area under the receiver operating curve (AUC) of sMVAP (65.4%, 73.3%, AUC 0.69) was higher than STOP-BANG (44.2%, 66.7%, AUC 0.55). Higher sMVAP (quintiles 4 and 5 or scores > 0.4) were significantly associated with OSA diagnosis (p=0.003), male gender (p=0.024), BMI ≥ 35 kg/m2 (p<0.001), and diabetes (p=0.001). No significant inter-quintile association was seen in age (p = .549), hypertension (p = .061), atrial fibrillation (p = .801), or heart failure (p = .305). CONCLUSIONS: This study supports that sMVAP scores are associated with OSA-risk in the elective surgery patient population. It is not inferior to STOP-BANG and considering its symptomless use, could be easily integrated into preoperative screening for OSA-risk. CLINICAL IMPLICATIONS: Further study in the validation of sMVAP in a larger group of elective surgical patients is warranted and may facilitate efficient preoperative screening. DISCLOSURES: no disclosure on file for Meena Khan; No relevant relationships by Weerapong Lilitwat, source=Web Response no disclosure on file for Melanie Lyons; No relevant relationships by Barbara Rogers, source=Web Response No relevant relationships by yuttiwat vorakunthada, source=Web Response

Early Peri-operative Outcomes Were Unchanged in Patients Undergoing Spine Surgery During the COVID-19 Pandemic in New York City.

BackgroundHealthcare resources have been greatly limited by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic halting non-essential surgical cases without clear service expansion protocols.Questions/PurposesWe sought to compare the peri-operative outcomes of patients undergoing spine surgery during the SARS-CoV-2 pandemic to a matched cohort prior to the pandemic.MethodsWe identified a consecutive sample of 127 adult patients undergoing spine surgery between March 9, 2020, and April 10, 2020, corresponding with the state of emergency declared in New York and the latest possible time for 1-month surgical follow-up. The study group was matched one-to-one based on age, gender, and body mass index with eligible control patients who underwent similar spine procedures prior to the SARS-CoV-2 outbreak. Surgeries performed for infectious or oncologic indications were excluded. Intra- and post-operative complication rates, re-operations, hospital length of stay, re-admissions, post-operative visit format, development of post-operative fever and/or respiratory symptoms, and SAR-CoV2 testing.ResultsA total of 254 patients (127 SARS-CoV-2 pandemic, 127 matched controls) were included. One hundred fifty-eight were male (62%), and 96 were female (38%). The mean age in the pandemic group was 59.8 ± 13.4 years; that of the matched controls was 60.3 ± 12.3. All patients underwent general anesthesia and did not require re-intubation. There were no significant differences in 1-month post-operative complication rates (16.5% pandemic vs. 12.6% control). There was one death in the pandemic group. No patients tested positive for the virus.ConclusionThis study represents the first report of post-operative outcomes in a large group of spine surgical patients in an area heavily affected by the SARS-CoV-2 pandemic.Electronic supplementary materialThe online version of this article (10.1007/s11420-020-09797-x) contains supplementary material, which is available to authorized users.

The Impact of Routine Cardiology Consultation on Critically Ill Patients with Elevated Troponin Levels

Cardiac troponin (cTn) is used to diagnose acute coronary syndrome (ACS). However, cTn can also be elevated in critically ill patients secondary to demand ischaemia or myocardial injury. In a meta-analysis of 20 different studies involving critically ill patients, cTn was found to be elevated in 43% of patients.1 Prior studies have evaluated the significance of cTn as a prognostic factor and mortality predictor in different clinical entities in intensive care units (ICU).2,3 However, the data on the impact of cardiology consultation on the outcomes in this specific context of critical care patients are limited. While prior studies have addressed such an impact on the outcomes among different groups of surgical patients,4,5 to the authors’ knowledge, no prior studies have examined that impact on critically ill patients with elevated cTn. This study aimed to investigate the impact of cardiology consultation on critically ill patients in the medical ICU with elevated cTn and no signs of ACS.

Non-medial infectious orbital cellulitis: etiology, causative organisms, radiologic findings, management and complications

BackgroundOrbital cellulitis is an ophthalmic emergency, which is associated with vision-threatening adverse effects. The purpose of this study is investigating etiology, radiologic findings, management and complications of patients with non-medial orbital cellulitis.MethodA retrospective medical record and radiologic file review of patients with infectious orbital cellulitis was performed to detect all patients with non-medial orbital cellulitis who referred to Khalili hospital from 2016 to 2019. Age, sex, origin of infection, size of collection or abscess, medical or surgical management, microbiology, first and final best-corrected visual acuity, duration of admission, and complications was recorded. Patients divided into two groups; medical management and surgical management groups and all of data compared between in this groups.ResultsOf ninety-six patients with infectious orbital cellulitis, 23 cases (14 male, 9 female) were included. Five patients (21.7%) were managed medically and 18 patients (78.3%) were managed surgically. Patients’ age range was 5–70 years old. Most common location for non-medial cellulitis was superior space (66.7% in surgical and 40% in medical group; p = 0.511). In 13 cases of surgical group (72.3%) were detected microorganisms. The mean ± SD of collection volume in medical group were 476.5 ± 290.93 mm3 and 2572.94 ± 1075.75 mm3 in surgical group (p < 0.001). Ten patients in surgical group had compressive optic neuropathy. The mean ± SD of collection volume was 3204.97 ± 879.88 mm3 in patient with compressive optic neuropathy and 1280.43 ± 880.68 mm3 in patient without compressive optic neuropathy (P < 0.001). One case complicated by subdural empyema and another case progressed to necrotizing fasciitis.ConclusionNon-medial orbital cellulitis is an uncommon but sight-threatening and life-threatening condition. Timely diagnosis and accurate management reduce morbidity and mortality. Combined surgery for patients with superior or supra-temporal and large non-medial abscess is recommended.

Evaluation of racial disparities in postoperative opioid prescription filling after common pediatric surgical procedures

BackgroundRacially disparate pain management affects both adult and pediatric patients, but is not well studied among pediatric surgical patients after discharge. The objectives were to evaluate racial disparities in pediatric postoperative opioid prescription filling. MethodsThis retrospective cohort study included black or white pediatric Medicaid patients who underwent tonsillectomy, supracondylar humeral fracture fixation, or appendectomy (2/2012–7/2016). Patients were followed for 14 days post-surgery to identify opioid prescription fills. Logistic regression models evaluated the association between race and the probability of filling an opioid prescription. ResultsAmong 39,316 surgical patients, the proportions of patients with post-surgical opioid prescriptions were 66.0%, 83.9%, and 68.5%, among tonsillectomy, supracondylar fracture, and appendectomy patients, respectively. The proportion of black appendectomy patients with a postoperative opioid prescription was significantly lower compared to white patients (65.0% vs. 69.2% respectively, p = 0.03), but was no longer significant after adjusting for other patient and provider characteristics. There were no differences by race in opioid prescription filling among other surgical patient groups. ConclusionsThe present study did not identify racial disparities in opioid prescription filling in adjusted analyses. Racial differences in unadjusted postoperative opioid prescription filling among appendectomy patients may be explained in part by longer postoperative length-of-stay among black children. Type of StudyPrognosis Study Level of EvidenceLevel II

Effect of K-line on posterior cervical surgery in patients with posterior longitudinal ligament ossification.

To evaluate the effect of K-line on posterior single-door decompression with fusion fixation (PFF) and posterior single-door decompression with non-fusion fixation (PNF) for patients with ossification of posterior longitudinal ligament (OPLL). A total of 65 patients with OPLL were analyzed retrospectively. They consisted of 44 patients with positive K-line, designated as the K ( +) group, and 21 patients with negative K-line, designated as K (-). The patients were also divided into a PFF group (38 patients) and a PNF group (27 patients). The Japanese Orthopaedic Association (JOA) score, C2-C7 Cobb angle, improvement rate of JOA score, and complications were calculated and statistically analyzed between the groups. In the K ( +) group, there were no significant differences in the incidence of C5 nerve root palsy and C2-C7 Cobb angle between the two groups of surgical patients, but there were significant differences in the improvement rate of JOA score and the incidence of axial pain. In the K (-) group, there were no significant differences in the incidence of axial pain, the incidence of C5 nerve root palsy, and preoperative C2-C7 Cobb angle between the two groups, but significant differences were observed in the improvement rate of JOA score and C2-C7 Cobb angle at the last follow-up. In the K ( +) group, the improvement rate of JOA score was higher and the incidence of axial pain was lesser in the PNF group than in the PFF group. In the K (-) group, the improvement rate of JOA score was higher in the PFF group than in the PNF group, and there was significant loss of C2-C7 Cobb angle in the PNF group.

Planning principles for radical surgical intervention for liver alveococcosis based on computed and magnetic resonance imaging

Aim. To develop the planning principles for radical surgical intervention for liver alveococcosis based on the computed and magnetic resonance imaging data.Materials and methods. The data of computed tomography and magnetic resonance imaging, as well as the results of treatment of 189 patients with liver alveococcosis in 2011–2020 were analyzed.Results. A sequence of data analysis of CT-scan and magnetic resonance imaging, consisting of several stages, is proposed. CT-scan and magnetic resonance imaging data of all patients were analyzed according to the developed algorithm, which was adapted to the planning stages of surgical treatment. The accuracy of CT-scan and magnetic resonance imaging in determining the localization of the parasitic process by sections and predicting the need for a two-stage resection of the liver, the use of total vascular isolation technique was 100%. The accuracy of CT-scan in the defining of anatomical variants of extrahepatic arteries and the presence of a significant accessory right hepatic vein of the liver was 98.6%, type of division of the portal vein – 97.2%. Radiation semiotics of the relationship of parasitic masses with the main vessels of the liver and the inferior vena cava were determined. The accuracy of CT-scan in the diagnosis of involvement of the hepatic arteries, portal and hepatic veins was 96.9%, 91.2% and 91.4%, respectively. In predicting circular resection of the inferior vena cava we recommend to use the cut-off of contact of parasitic masses around it more than 180 ° (AUC = 0.950). With borderline volumes of liver remnant (30–35%), prolonged hyperbilirubinemia, suspected development of secondary biliary cirrhosis, magnetic resonance imaging with gadoxetic acid makes it possible to assess the functional state of the parenchyma. This may require additional preoperative therapy, planning a two-stage resection or the process may be considered unresectable in the diagnosis of severe fibrosis.Conclusion. The developed CT-scan/ magnetic resonance imaging data analysis algorithm allows to determine the clinical and surgical group of patients with liver alveococcosis and to plan the type of surgical intervention. Additional option of magnetic resonance imaging with gadoxetic acid in evaluating of functional state of liver remnant allows you to adjust surgical tactics in a number of clinical situations.

The impact of adjuvant surgical treatment of nontuberculous mycobacterial pulmonary disease on prognosis and outcome

BackgroundLung resection in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) has been reported to be associated with favorable outcomes. However, little is known regarding the risk and prognostic factors for refractory and recurrent cases. We aimed to evaluate the overall impact and benefit of adjuvant lung surgery by comparing NTM-PD patients who underwent adjuvant lung resection with those treated exclusively with antibiotics. We also investigated the efficacy of serum IgA antibody against glycopeptidolipid (GPL) core antigen (GPL core antibody) to monitor disease activity and predict the recurrence of disease after adjuvant lung resection.MethodsWe retrospectively evaluated the clinical characteristics and surgical outcomes of 35 patients surgically treated for NTM-PD. Furthermore, we compared surgically treated patients and control patients treated exclusively with antibiotics who were matched statistically 1:1 using a propensity score calculated from age, sex, body mass index, and radiologic features of disease.ResultsIn the surgically treated patients, the median age was 58 (interquartile range, 47–65) years and 65.7% were female. Twenty-eight patients had Mycobacterium avium complex. Operations comprised four pneumonectomies, two bilobectomies, one bilobectomy plus segmentectomy, 17 lobectomies, two segmentectomies, and nine lobectomies plus segmentectomies. Postoperative complications occurred in seven patients (20%), there were no operative deaths, and 33 (94.3%) patients achieved negative sputum culture conversion. Refractory and recurrent cases were associated with remnant bronchiectasis, contralateral shadows, and positive acid-fast bacilli staining or culture. Of 28 statistically matched pairs, long-term sustained negative culture conversion was observed in 23 (82.2%) surgical group patients and in 14 (50.0%) non-surgical group patients (0.0438). The mortality rate was lower in the surgical group, but did not reach statistical significance (one in the surgical group and four in the non-surgical group, p = 0.3516). GPL core antibody was correlated with disease activity and recurrence.ConclusionsNTM-PD patients who underwent adjuvant lung resection experienced overall favorable outcomes and achieved sputum culture conversion more frequently. Long-term mortality may have been reduced by this procedure, and the level of GPL core antibody was shown to be a good clinical indicator of disease activity after surgery.

Propensity Score Matching Analysis for the Role of Surgery in Small Cell Lung Cancer

Background: The role of surgery for small cell lung cancer (SCLC) is not clear. We aimed to evaluate this issue using a population-based database. Methods: Patients diagnosed between 2004 and 2014 with SCLC staged T1–4 N0–2 M0 disease were retrieved from the Surveillance, Epidemiology, and End Results database. Propensity score matching (PSM) was used to reduce bias between the surgical and nonsurgical patient groups. The Kaplan-Meier method and Cox regression analysis were used to compare overall survival (OS) for the matched patients. Results: A total of 8,811 patients were retrieved, including 863 patients who underwent surgical resection. After 1:1 PSM, a matched cohort with 1,562 patients was generated. In the matched cohort, surgery was associated with 5-year OS improvement (from 16.8 to 36.7%, p < 0.001) and lung cancer-specific survival improvement (from 21.6 to 43.2%, p < 0.001). Survival benefits of surgery were significant in all subgroups, including N1–2 disease, except for patients with a tumor size >5.0 cm or T3 disease. Conclusions: Patients with SCLC of limited stage can benefit from surgery, including N1–2 disease. However, patients with a tumor size >5.0 cm or advanced T stage may be unable to benefit from surgery.

Surgery in times of COVID-19\u2014recommendations for hospital and patient management

BackgroundThe novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has escalated rapidly to a global pandemic stretching healthcare systems worldwide to their limits. Surgeons have had to immediately react to this unprecedented clinical challenge by systematically repurposing surgical wards.PurposeTo provide a detailed set of guidelines developed in a surgical ward at University Hospital Wuerzburg to safely accommodate the exponentially rising cases of SARS-CoV-2 infected patients without compromising the care of emergency surgery and oncological patients or jeopardizing the well-being of hospital staff.ConclusionsThe dynamic prioritization of SARS-CoV-2 infected and surgical patient groups is key to preserving life while maintaining high surgical standards. Strictly segregating patient groups in emergency rooms, non-intensive care wards and operating areas prevents viral spread while adequately training and carefully selecting hospital staff allow them to confidently and successfully undertake their respective clinical duties.

Comparison of temporomandibular joint function and morphology after surgical and non-surgical treatment in adult condylar head fractures

PurposeThe aim of this study was to evaluate whether surgical treatment can distinctly improve temporomandibular joint (TMJ) function and morphology in adult patients with condylar head fractures (CHFs) when compared with conservative treatment. Patients and methodsA retrospective study was performed to evaluate surgical and conservative outcomes in all patients who had suffered CHFs. In this study, all patients were divided into a surgical group and a conservative group. In the surgical group patients were treated by open reduction and internal fixation (ORIF) combined disc anchorage, while in the conservative group patients were treated by a removable splint combined with intermaxillary elastics. Clinical and radiological outcomes were evaluated and functional outcomes were assessed using the Helkimo index score. Paired t-tests, Wilcoxon signed rank tests, independent t-tests and χ2 tests were used to assess inter-group differences. Results75 TMJs in 56 patients were included in this study and were divided into a surgical group (56 TMJs in 40 patients) and a conservative group (19 TMJs in 16 patients). The results showed that the Helkimo index score for TMJ in the surgical group was better than in the conservative group (pAi = 0.032, pDi = 0.001, respectively). Ramus height in the surgical group (61.08 ± 4.04 mm) recovered more than in the conservative group (54.82 ± 3.06 mm) (p = 0.012). Discs became shorter, moved further forward, and became severely distorted in the conservative group (disc length = 7.32 ± 1.35 mm). In contrast, discs became longer, retained a normal disc–condyle relationship, and formed a normal shape in the surgical group (disc length = 11.05 ± 2.07 mm) (p = 0.003). According to the MRI images, joint effusion, retrodiscal tear, and lateral capsular tear were better cured in the surgical group (p = 0.001, p < 0.001, p = 0.012, respectively). ConclusionBased on these results, it seems that surgical treatment of condylar head fractures should be the preferred approach if there are no contraindications for general anesthesia.

Serum miR-125b levels associated with epithelial ovarian cancer (EOC) development and treatment responses

ABSTRACT Downexpression of miRs was associated with tumor development, progression, and metastasis. This study explored the serum levels of miR-125b in patients with epithelial ovarian cancer (EOC) and to assess its diagnostic value and monitor treatment responses for patients with EOC. A total of 379 individuals were recruited and assigned to the study groups. RT-qPCR analysis was performed to confirm the association of serum miR-125b levels with tumor stages and treatment responses. The median serum levels of miR-125b in patients with EOC were significantly lower than that of other controls (P < 0.0001). Serum miR-125b in patients with high FIGO stage (III+IV), lymph node metastasis, and chemoresistance were lower than that in patients with early-stage (stage I+ II; P < 0.001), without lymph metastasis (p = 0.032) and chemosensitivity (P < 0.001). Low levels of miR-125b had a poor prognosis in patients with EOC. Using a median value of 0.748 to separate EOC from other controls, the sensitivity and specificity reached 0.76 (95% CI 0.75 to 0.85) and 0.416 (95% CI 0.26 to 0.55), respectively. Serum miR-125b showed a statistically significant difference between preoperative and postoperative patients in surgical patient groups (P = 0.003). Serum miR-125b levels were lower in patients with chemoresistance than that in patients with chemosensitivity (P < 0.0001). Serum miR-125b in combination with serum CA125 improved both sensitivity and specificity in diagnosis of EOC (P < 0.001). This study demonstrated that serum miR-125b levels were a useful diagnostic biomarker and biomarker to predict the responses to chemotherapy in patients with EOC.

Surgery for the Very Old: Are Nonagenarians Different?

Octogenarians and nonagenarians are considered the "very old" and are often viewed as one group. Americans are aging, with the proportion of the very old expected to increase from 1.9 per cent of the population to 4.3 per cent in 2050. This study aimed to underscore the differences in surgical trends, demographics, and outcomes between octogenarians and nonagenarians. The ACS-NSQIP database (2007-2012) was used to derive the type of surgeries, demographics, and outcomes of octogenarian and nonagenarians undergoing nonemergent vascular, orthopedic, and general surgery procedures. Between 2007 and 2012, nonagenarians accounted for an increasing percentage of surgeries (85 to 121 per 10,000 surgeries, relative risk = 1.42; 95% CI: 1.30-1.54) across surgical specialties, including vascular, general, and orthopedic surgery, whereas the percentage of octogenarians undergoing surgery remained unchanged. Nonagenarians had a higher 30-day perioperative mortality and a longer hospital stay than octogenarians after vascular, orthopedic, and general surgery procedures. Nonagenarians are a rapidly growing group of surgical patients with significantly higher perioperative mortality and longer postoperative hospital stay. The impact of surgery on the quality of life of nonagenarians needs to be studied to justify the increasing healthcare costs.

Early screw fixation versus casting in the treatment of acute Jones fracture

Purpose There is considerable variability in the literature in treatment of Jones fracture. The purpose of this study is to compare between the outcomes of cast immobilization and intramedullary screw fixation in treatment of acute Jones fracture type II and type III. Our results concluded that treatment of Jones fracture by early intramedullary screw fixation showed early union and return to previous activity in shorter time than the conservative treatment. Patients and methods In this prospective study, 40 patients were selected from Kasr El Ainy from October 2014 to May 2015. Radiographs were assessed for displacement. Dameron, Lawrence, and Quill classification was used to determine type of fracture. A total of 20 patients were treated conservatively by below-knee cast, and the average duration for cast application was 7 weeks. A total of 20 patients underwent operative management in the sort of percutaneous fixation by cannulated screw. We only used compression bandage after the operation; however, slab was used if there were any associated ipsilateral injuries. We followed up the patients with radiograph for union and by American Orthopedic Foot and Ankle Society Score to evaluate the function. Results All the surgical group patients achieved union, with an average clinical union of 7.5 weeks, and the cast group had an average union of 12.5 weeks, with highly significant difference (P Conclusion Early screw fixation in the treatment of acute Jones fracture is preferable than conservative treatment in patients with high-demand physical activity who want to return early to their work, where we have to take in consideration the financial cost of the operation versus the cast application. So, tailoring of the management plan to the patient activity and financial capability is of utmost importance.