Postoperative Pathologies Research Articles

Orthopedic Applications of Single-photon Emission Computed Tomography/Computed Tomography in Identifying Pain Generators in the Pre- and Post-operative Patient

Postoperative and benign bone pathologies can sometimes be difficult to elicit on purely anatomical-based imaging. Single-photon emission computed tomography-computed tomography (SPECT-CT) is an established modality with emerging applications in the musculoskeletal field that combines cross-sectional structural imaging with the metabolic data. It is thought to offer certain clinical advantages to conventional imaging modalities as it can be sensitive to conditions before they appear as a structural abnormality. The aim of this pictorial review is to demonstrate the musculoskeletal applications of SPECT/CT in the pre- and post-operative orthopedic patient. The evidence for the musculoskeletal application of SPECT/CT is reviewed in various pre- and post-operative patients focusing on the advantages and disadvantages of this imaging modality alongside conventional imaging. Alongside this we present a series of musculoskeletal SPECT/CT cases in postoperative spinal and extremity joints identifying such pathologies as loosening, pseudoarthroses and prosthetic joint infection. We also include cases on the nonoperative joint identifying pain generators for targeted therapy. This review has shown that SPECT/CT can be a useful adjunct alongside other conventional imaging modalities in identifying musculoskeletal pain generators in the postoperative patient. It is especially useful in situations where anatomical imaging modalities alone provide insufficient diagnostic information or lack of symptomatic improvement. SPECT/CT is therefore likely to remain an complimentary investigative tool for unidentified musculoskeletal pain or for postoperative patients with metalwork in situ.

Evaluating Postoperative Outcomes and Investigating the Usefulness of EU-TIRADS Scoring in Managing Pediatric Thyroid Nodules Bethesda 3 and 4

The aim was to assess postoperative outcomes in pediatric thyroid nodules with atypia of undetermined significance (AUS/FLUS) or suspicious for a follicular neoplasm (SFN) and their respective the European-Thyroid Imaging Reporting and Data System (EU-TIRADS) scores. Forty-four pediatric patients at a single center with thyroid nodules classified as AUS/FLUS or SFN from August 2019 to December 2022 were retrospectively reviewed. Data on demographics, thyroid function, nodule size, and ultrasonographic features were collected. Postoperative pathologies were categorized into benign, low-risk, and malignant neoplasms according to the World Health Organization 2022 criteria, and EU-TIRADS was used for retrospective radiological scoring. Among 21 (47.7%) of patients who had surgical intervention, 72% had Bethesda 3 and 28% had Bethesda 4 thyroid nodules. Post-surgical histopathological classifications were 43% benign, 19% low-risk, and 38% malignant. Of note, EU-TIRADS 3 and 5 scores were present in 44% and 56% of the benign cases, respectively. Malignant cases tended to produce higher EU-TIRADS scores, with 64% rated as EU-TIRADS 5. Bethesda category 4 nodules had a 66% malignancy rate, significantly higher than the 27% in category 3. A substantial proportion of histologically benign cases were classified as EU-TIRADS 5, suggesting that EU-TIRADS may lead to unnecessary biopsies in benign cases. Malignant cases were more likely to have a higher EU-TIRADS score, indicating a positive correlation with malignancy risk, particularly in Bethesda 4 cases. However, the EU-TIRADS system’s predictive value for malignancy in Bethesda 3 cases was poorer.

Prognostic Value of Systemic Inflammatory Markers and Scoring Systems in Predicting Postoperative 30-Day Complications and Mortality in Colorectal Cancer Surgery: A Retrospective Cross-Sectional Analysis.

Cancer-related systemic inflammation causes the increase of proinflammatory markers and acute phase proteins. Activation of systemic inflammatory response has been linked to poorer prognosis in colorectal cancer. This study aims to evaluate the prognostic value of preoperative systemic inflammatory markers and inflammation/nutrition scoring systems in predicting the postoperative early period (first 30 days) complications and mortality outcomes of patients who underwent curative surgery for colorectal cancer in our clinic. This study was designed as a retrospective single-arm cross-sectional study. In this study, 300 patients older than 18 years of age who underwent open and laparoscopic surgery for colorectal cancer were included. Demographic characteristics of the patients, preoperative hemogram and biochemical values, operation characteristics, postoperative tumor pathologies and disease stages were recorded. Neoadjuvant chemoradiotherapy, Systemic Inflammation Score, Modified Glasgow Prognostic Score, Naples Prognostic Score and Prognostic Nutritional Index had a significant effect on the first 30-day mortality (p-values: <0.001, 0.007, <0.001, <0.001, <0.001, respectively). The results suggest that certain preoperative inflammation and nutrition scores might serve as indicators for potential early postoperative adverse outcomes in colorectal cancer surgery.

Retrospective Comparison between Pre Operative Fine Needle Aspiration Cytology and Postoperative Histopathological Result after Parotidectomy in Tertiary Hospital Saudi Arabia

Abstract Purpose: To assess the diagnostic accuracy of fine-needle aspiration cytology (FNAC) of parotid gland tumors and to compare between diagnostic accuracy of FNAC and tru-cut biopsy. Materials and Methods: An observational, retrospective noninterventional study including 95 patients who underwent both preoperative fine-needle aspiration biopsy and postoperative surgical pathologies in Aseer Region, Saudi Arabia between January 2015 and November 2022 was conducted. Results: Males (53.7) were more than females (46.3%). The most common age group was found to be more than 50 years (36.8%), followed by 41–50 years (25.3%). Only (1.9%) FNAC result report was described according to the Milan system for salivary gland cytopathology and the result was nonneoplastic II, while (98.1%) was not. FNAC sensitivity and specificity were found to be 60% and 100%, respectively. Tru-cut biopsy sensitivity and specificity were found to be 100% and 100%, respectively. No significant association was found between FNAC and tru-cut biopsy results. Conclusion: Overall, this study can conclude that FNAC is a simple, safe, and cost-effective diagnostic method in the investigation of parotid gland tumors with high specificity and accuracy and can prevent many unnecessary operations as a cheap and reliable diagnostic tool that can be used for preoperative diagnosis of carcinomas. It was found that tru-cut biopsy has more sensitivity and specificity than FNAC.

Our Experience With Left Colon and Rectal Cancer Surgery and the Impact of Preoperative Sarcopenia on Complication Rates.

Evidence about the importance of sarcopenia in patients operated on for gastrointestinal cancers and that it may have both early and long-term impacts is expanding. In our study, we aimed to evaluate the impact of sarcopenia on the outcomes of the patients we operated on for left colon and rectum cancer. We retrospectively evaluated the electronic records of 38 patients operated on for left colon and rectal cancer between 2010 and 2020, and demographic variables, clinical stages, laboratory tests, body mass index (BMI), psoas muscle index (PMI), pathological stages, and Dindo Clavien complication scores were interpreted. We also assigned our patients into two groups according to their preoperative PMI values. We compared the first group of 12 patients with preoperative sarcopenia with the second group of 26 patients without preoperative sarcopenia. Of the 38 patients who underwent curative surgery for left colon and rectal cancer, 20 were female and 18 were male. The median age of the group was 59.9 years. The most common tumour localization was in the rectosigmoid region in 17 patients, and the tumour in 6 patients was in the left colon. Therapy had been initiated with neoadjuvant treatment in 19 patients. At the preoperative evaluation, sarcopenia was present in 12 patients. Thirty-four patients underwent robot-assisted surgery. Postoperative pathologies were reported as stage 3 in 15 patients. Complications were reported in 17 patients, and nine were minor (Dindo-Clavien score < 3), but in eight patients, they were moderate to severe (Dindo-Clavien score ≥ 3). When the first group, 12 patients with preoperative sarcopenia, and the second group, 26 patients without preoperative sarcopenia, were compared, the patients with sarcopenia were found to be older (p=0.001), and male patients were in the majority (p=0.017). The postoperative follow-up of 12 patients with preoperative sarcopenia revealed that 7 (58.8%) had complications. Complications were observed in 10 (38.4%) patients in the second group. When the two groups were compared, the risk of developing complications was significantly higher in the sarcopenia group (p=0.016). Only one patient in the first group had moderate to severe complications, but seven patients without sarcopenia had moderate to severe complications. Our study revealed that many patients we have operated on for left colon and rectal cancer have preoperative sarcopenia for which we should care. The sarcopenia rate was higher in males and elderly patients, and the risk of overall postoperative complications increased significantly in patients with preoperative sarcopenia. In consequence, the results of our study provide evidence that preoperative sarcopenia status is an important parameter to determine the risk status of the patient, and patients with preoperative sarcopenia should be monitored more closely. Thus, we may be able to diagnose and intervene early in the complications.

Scheuermann Kyphosis: Current Concepts and Management.

Scheuermann's kyphosis (SK) is a developmental deformity of the spine that affects up to 8% of children in the US. Although, the natural progression of SK is noted to be gradual over years, severe deformity can be associated with significant morbidity. Thorough clinical examination and interpretation of relevant imaging help differentiate and confirm this diagnosis. Treatment includes both operative and nonoperative approaches. The purpose of this article is to provide an updated overview of the current theories of its pathogenesis, as well as the principles of diagnosis and treatment of SK. Although a definitive, unified theory continues to be elusive, numerous reports in the past decade provide insight into the pathophysiology of SK. These include alterations in mechanical stress and/or hormonal disturbances. Candidate genes have also been identified to be linked to the inheritance of SK. Updates to nonoperative treatment include the effectiveness of dedicated exercise programs, as well as the types and duration of orthotic treatment. Advances in surgical technique can be observed with a trend toward a posterior-only approach, with supporting evidence for careful evaluation of both the sagittal and coronal planes to determine fusion levels in order to avoid postoperative junctional pathologies. SK is an important cause of structural or rigid kyphosis. It can lead to significant morbidity in severe cases. Treatment is based on curve magnitude and symptoms. Nonoperative treatment consists of physical therapy in symptomatic patients, and bracing can be added for skeletally mature patients. Operative management can be considered in patients with large, progressive, and symptomatic deformity. Future studies can benefit from a focused investigation into patient-reported outcomes after undergoing appropriate treatment.

Clinical and radiographic features of adult calcified thoracic disc herniation: a retrospective analysis of 31 cases.

To analyze the clinical and radiographic characteristics of calcified thoracic disc herniation (CTDH) and explore the possible pathogeneses. This is a retrospective clinical review of prospectively collected imaging data based at a single institute from 2004 to 2021. Clinical and radiographic parameters of CTDH patients were retrospectively collected and analyzed. All 31 patients included presented thoracic myelopathy with a 17.05-month preoperative disease duration. Three (9.7%) patients had a history of trauma, and the rest had insidious onset. The average spinal canal ventral-occupying ratio was 74.90 ± 15.16%. The most prominent radiographic feature was the calcification of the nucleus pulposus in the intervertebral disc and the calcified lesion contiguous with the disc space protruding into the spinal canal. Three main imaging forms of CTDH were found: calcium-ringed lesion (5), heterogeneous calcification lesion (19), and homogeneous calcification lesion (7). The radiographic manifestations, intraoperative findings, and postoperative pathologies of the three subtypes were different. The calcium-ringed lesion type was younger and had a shorter preoperative duration and significantly lower mJOA score. A special case was observed conservatively for five years, which suggested that a heterogeneous lesion could progress to a homogeneous lesion. Adult CTDH is a special thoracic disc disease with insidious onset, a long course, and a high spinal canal-occupying ratio. Calcium deposits in the spinal canal originate from the nucleus pulposus. The intraoperative findings and postoperative pathology of subtypes are different, which might indicate different pathological mechanisms.

Glioblastoma in the contralateral cerebral hemisphere with previous surgery for meningioma: A case report

Meningioma and glioblastoma (GBM) are 2 common intracranial tumors with different pathophysiologies and prognoses. It is rare for these 2 kinds of tumors to occur in the same patient. Most of the similar cases reported in the literature have been treated with radiotherapy, while cases without radiotherapy are rare. In particular, GBM in the contralateral cerebral hemisphere after resection of meningioma has not been reported. We present a case of a 66-years-old man with GBM in the right temporal lobe after previous resection of a benign meningioma of the left frontal lobe without radiotherapy. The patient was admitted to our hospital for the first time because of right upper limb weakness. Brain magnetic resonance imaging indicated a space-occupying lesion in the left frontal area. Surgical treatment was performed, and postoperative pathology confirmed a meningioma. The patient was readmitted to the hospital 3 years after surgery of the meningioma due to a new lesion of the right temporal lobe and underwent reoperation. The postoperative pathological results showed GBM. The patient underwent 2 operations, and the postoperative pathologies were meningioma and GBM. In addition, the patient received concurrent chemoradiotherapy and 2 cycles of temozolomide adjuvant chemotherapy. During the last 4 months of follow-up, the patient was in good condition with no recurrence of the tumor. The development of GBM without radiotherapy after meningioma surgery is very rare, especially at different sites, and it is necessary to accumulate relevant cases to reveal the causes of the disease and provide more evidence for the treatment of similar patients in the future.

Analysis of postoperative intraocular pathologies in patients with mature cataracts.

To examine the prevalence and risk factors of intraocular pathologies after mature cataract surgery. The medical records of 115 patients (115 eyes) diagnosed with brunescent or white cataracts, who underwent surgery at a single primary center between January 2018 and August 2021 were retrospectively reviewed. Dense cataracts precluded preoperative fundus examination in all eyes; however, patients with fundus examination results within 3 months after cataract surgery were included. Logistic regression analyses were performed to identify factors associated with intraocular pathologies. Intraocular pathologies were observed in 37 eyes (32.2%) 11.8 ± 13.9 days postoperatively. The most common abnormalities were drusen (6.1%), myopic degeneration (5.2%) and diabetic retinopathy (4.3%). Intraocular pathology in the fellow eye was associated with posterior segment pathology in mature cataract eyes (odds ratio, 47.72; P < 0.001). The prevalence of each intraocular pathology found after mature cataract surgery was unremarkable. This study provides clinically useful evidence for clinicians to explain the risk of posterior segment pathology in patients with mature cataracts.

Effect of segmental lordosis on early-onset adjacent-segment disease after posterior lumbar interbody fusion.

Although several reports have described adjacent-segment disease (ASD) after posterior lumbar interbody fusion (PLIF), there have been only a few reports focusing on early-onset ASD occurring within 3 years after primary PLIF. The purpose of this study was to investigate the prevalence and postoperative pathologies of early-onset ASD and its relation with radiological parameters such as segmental lordosis (SL). The authors reviewed a total of 256 patients who underwent single-segment PLIF at L4-5 for degenerative lumbar spondylolisthesis (DLS) and were followed up for at least 5 years. The definition of ASD was a symptomatic condition requiring an additional operation at the adjacent fusion segment in patients who had undergone PLIF. ASD occurring within 3 years after primary PLIF was categorized as early-onset ASD. As a control group, 54 age- and sex-matched patients who had not suffered from ASD for more than 10 years were selected from this series. There were 42 patients with ASD at the final follow-up. ASD prevalence rates at 3, 5, and 10 years postoperatively and at the final follow-up were 5.0%, 8.2%, 14.1%, and 16.4%, respectively. With respect to ASD pathologies, lumbar disc herniation (LDH) was significantly more common in early-onset ASD, while lumbar spinal stenosis and DLS occurred more frequently in late-onset ASD. Significant differences were detected in the overall postoperative range of motion (ROM) and in the changes in ROM (ΔROM) at L3-4 (the cranial adjacent fusion segment) and changes in SL (ΔSL) at L4-5 (the fused segment), while there were no significant differences in other pre- and postoperative parameters. In stepwise logistic regression analysis, ΔSL was identified as an independent variable (p = 0.008) that demonstrated significant differences, especially in early-onset ASD (control 1.1° vs overall ASD -2.4°, p = 0.002; control 1.1° vs early-onset ASD -6.6°, p = 0.00004). The study results indicated that LDH was significantly more common as a pathology in early-onset ASD and that ΔSL was a major risk factor for ASD, especially early-onset ASD.

Analysis of clinicopathological features of primary diaphragm tumors: A single-center study.

Background and ObjectivesPrimary diaphragm tumors are rare. The aim of this study was to explore the clinicopathological features of primary diaphragm tumor patients who underwent surgical treatment in our center to improve the diagnosis and treatment of this disease.MethodsClinical data of patients with primary diaphragm tumor who underwent surgery in our hospital from 2004 to 2019 were reviewed and analyzed.ResultsA total of 18 patients were enrolled. The male:female ratio was 8:10, and the median age was 58 years old (35–74 years old). Most patients included in this study had no typical clinical symptoms. Nine tumor cases were distributed in the left and right diaphragms separately, whereas 11 cases were located at the diaphragm angle. The diaphragm of 12 patients was reconstructed by direct suture. All postoperative pathologies showed that the tumors were benign, and cysts were observed in most of the cases (5/18).ConclusionsThere are no difference in distribution of gender and distribution on both sides of the diaphragm. In addition, primary diaphragm tumor is common in middle‐age patients. Most cases occur in the diaphragm angle and are characterized by cyst lesions. Surgical resection is an effective treatment option for primary diaphragm tumor.

ECG changes after non-cardiac surgery: a prospective observational study in intermediate-high risk patients.

Efforts to mitigate the risk for perioperative cardiac events focus on both patient's and operation's risk and often include a preprocedural electrocardiogram (ECG). The merits of postprocedural ECG for detection of occult cardiac events occurring during surgery are unknown. We aim to explore the incidence of pre, and new postprocedural ECG pathologies in an intermediate-high risk population undergoing non-cardiac surgery. This single-center, prospective, observational study, included patients older than 18 years with at least two cardiovascular risk factors who were scheduled for non-cardiac surgery. All patients had pre, and postprocedural ECG. The ECG was analyzed and coded according to the Minnesota criteria. A multivariable logistic regression analysis was performed for indices associated with new postoperative ECG pathologies. A total of 217 patients were enrolled. Preoperative pathologic ECG changes were recorded in 62.2% of the patients. Postoperatively, new ECG pathologies were documented in 49.8% of patients, most commonly T-wave changes (36.4% of changes). Pathologic ECG changes at baseline (OR 3.15, 95% CI [1.61-6.17]; P<0.01), diabetes (OR 1.93, 95% CI [1.02-3.64]; P=0.04), history of ischemic heart disease (OR 2.14, 95% CI [1.03-4.47]; P=0.04), higher volumes of fluid replacement (OR 1.70, 95% CI [1.10-2.61]; P=0.01) and higher levels of preoperative hemoglobin (OR 1.24, 95% CI [1.04-1.47]; P=0.01) were all independently associated with postoperative ECG changes. Pre-, but most importantly, postoperative ECG changes are common in intermediate-high risk surgical patients. Postoperative ECG may be valuable to disclose silent cardiovascular events that occurred during surgery.

Primer Mediastinal Kist ve Tümörler: 10-Yıllık Deneyim

Objective : To present the investigations related to the symptoms, surgical techniques, post-operative complications and pathologies of the cases with mediastinal cysts and masses. Material and Methods : Ninety cases with mediastinal cysts were evaluated retrospectively between 2009-2019. Patients were investigated regarding age, gender, complaints, radiological location of cysts, pre-operative diagnosis, type of surgeries, post-operative complications, removal of drains and pathologies. Results : Of cases, 39 (43.3%) were men, and 51 (56.7%) were women. Mean age was 44, and 48.9% had no complaints. The most common complaints reported were, in turn, chest pain (41.3%), dispnea (34.8%) and cough (15.2%).Without any differentiation between benign and malignant cases, 74.4, 20 and 5.6% of the cysts were located in anterior, middle and posterior mediastinum, respectively. Preoperative diagnosis was performed by transthoracic or USG tru-cut biopsy in 8.9% of patients. For diagnostic and threapeutic purposes, 61.1%, 21.1% and 10% of patients were operated through thoracotomy, sternotomy and video-assisted thoracic surgery (VATS) respectively, while 7.8% were operated with first thoracotomy and then VATS. The drains were removed approximately on 5th day. The most common post-operative complications were atelectasis and secretion, and mortality rate was found as 2.2%. The post-operative pathologies were benign in 63.3% and malignant in 36.7% of the cases. Frequencies of pathologies were respectively as follows: thymic diseases (45.5%), neurogenic tumors (12.2%), developmental cysts (10%), Hodkgin’s lymphomas (4%) and hydatid cysts (4%). Conclusion : There is no need for invasive radiological interventions with the mediastinal structures in non-invasive cases for pre-operative diagnosis. Surgery is an effective method in the diagnosis and treatment of patients without invasion to surrounding tissues, and for whom no lymphomas and germ-cell tumors are considered.

Endoscopic Trans-Lateral Molar Approach to Infratemporal Fossa Lesions.

To study the endoscopic trans-lateral molar (ETLM) approach to infratemporal fossa (ITF) lesions and analyze the advantages and disadvantages of this method. Four cases of ITF lesions were analyzed retrospectively. The clinical features, diagnosis and treatments, the operative process, and clinical applications of this surgical approach were discussed. Postoperative pathologies were 2 pleomorphic adenomas, 1 schwannoma, and 1 inflammatory lesion. All patients had self-resolving cheek swelling and pharyngalgia in the short term, but 2 patients had numbness in the long term. There was no infection or bleeding in the postoperative period, and no difficulty in chewing after disease recovery. There was no tumor recurrence during the follow-up period. The ETLM approach is convenient, minimally invasive, and allows complete excision of benign ITF lesions, posterior to the lateral pterygoid muscle and mainly below the level of the hard palate. It is a simple and direct access to the ITF, but it is a narrow access because of the limitations of bones and soft tissues. Appropriate patient selection is mandatory for successful surgery.

Clinical outcomes of hysterectomy for benign diseases in the female genital tract: 6 years' experience in a single institute.

BackgroundHysterectomy is one of the major gynecologic surgeries. Historically, several surgical procedures have been used for hysterectomy. The present study aims to evaluate the surgical trends and clinical outcomes of hysterectomy performed for benign diseases at the Yeungnam University Hospital.MethodsWe retrospectively reviewed patients who underwent a hysterectomy for benign diseases from 2013 to 2018. Data included the patients’ demographic characteristics, surgical indications, hysterectomy procedures, postoperative pathologies, and perioperative outcomes. ResultsA total of 809 patients were included. The three major indications for hysterectomy were uterine leiomyoma, pelvic organ prolapse, and adenomyosis. The most common procedure was total laparoscopic hysterectomy (TLH, 45.2%), followed by open hysterectomy (32.6%). During the study period, the rate of open hysterectomy was nearly constant (29.4%–38.1%). The mean operative time was the shortest in the single-port laparoscopic assisted vaginal hysterectomy (LAVH, 89.5 minutes), followed by vaginal hysterectomy (VH, 96.8 minutes) and TLH (105 minutes). The mean decrease in postoperative hemoglobin level was minimum in single-port LAVH (1.8 g/dL) and VH (1.8 g/dL). Conversion to open surgery or multi-port surgery occurred in five cases (0.6%). Surgical complications including wound dehiscence, organ injuries, and conditions requiring reoperation were observed in 52 cases (6.4%). ConclusionMinimally invasive approach was used for most hysterectomies for benign diseases, but the rate of open hysterectomy has mostly remained constant. Single-port LAVH and VH showed the most tolerable outcomes in terms of operative time and postoperative drop in hemoglobin level in selected cases.

Xanthogranulomatous pyelonephritis: an analysis of 41 cases

Objective To discuss the clinical diagnosis and treatment of xanthogranulomatous pyelonephritis (XGP). Methods Clinical data of 41 XGP patients admitted from May 1981 to December 2017 were retrospectively analyzed. There were 17 male cases and 24 female cases, aged from 23 to 78 years, with an average age of 57 years. All were unilateral lesions, including 19 cases on the left and 22 cases on the right. Disease duration ranged from 1 week to 12 years, with an average of 3.5 years. The clinical manifestations showed that 7 cases with gross hematuria (17.1%), 16 cases with palpable flank or abdominal mass (39.0%), 36 cases with flank pain (87.8%), 26 cases with acute or intermittent fever (63.4%) and 17 cases with weight loss (41.5%). Laboratory findings showed that 28 cases with leukocytosis (68.3%), 24 cases with anemia (58.5%), 27 cases with pyuria (65.9%), positive urine culture 19/34 (55.9%) , positive urine lipid-laden macrophages 3/14(21.4%) , and 20 cases with rapid erythrocyte sedimentation rate (48.8%). Imaging examination: among 35 patients who received CT examination, 25 were diagnosed as XGP, mainly presenting diffuse changes in the kidney with enlarged renal shadow, accompanied by diffusive distribution of multiple low-density lesions. There was no obvious enhancement in the low-density lesions on enhanced scan, accompanied by thickening of renal fascia, adhesion to psoas major muscle or involvement of surrounding tissues and organs. According to the imaging results, there were 33 cases of diffuse type and 8 cases of localized type in this group. Renal biopsy was performed 11 cases and 3 cases were diagnosed as XGP. Results All patients were treated with surgical procedure. 33 patients with diffuse type were performed nephrectomy. 6 of the 8 patients with localized type underwent partial nephrectomy successfully, and the other 2 patients underwent nephrectomy due to severe renal adhesion and unclear lesion boundaries. All postoperative pathologies suggested xanthogranulomatous pyelonephritis. Patients were followed up for 9 months to 10 years postoperatively, with an average of 4.5 years. All patients had no recurrence. Conclusions The clinical manifestations of XGP are lack of specificity. Diagnosis is difficult and depends on pathology. According to imaging examination, lesions can be divided into diffuse type and localized type. Nephrectomy and partial nephrectomy were performed respectively. Key words: Pyelonepritis, xanthogranulomatous; Diagnosis; Treatment; Surgery

Remote Patient Monitoring: A Systematic Review.

Introduction: Remote patient monitoring or telemonitoring aims at improving patient care through digitally transmitted health-related data. That allows early detection of disease decompensation and intervention, patient education and improves patient-physician relationship. Despite its relevance, there are no comprehensive reviews evaluating the variables discussed by clinical studies on telemonitoring. Methods: A systematic literature search of PubMed was performed to identify studies about telemonitoring published between 2000 and 2018. These had to be case reports with >5 cases, comparative or clinical studies/trials. The following variables were evaluated: year of publication, author's country, discussed topic, objective of study, follow-up time, number of telemonitoring patients, primary outcome, use of teleconsultation and tele-education, presence of a control group, effectiveness of telemonitoring, telemonitoring strategies, and level of evidence. Results: After screening 947 records, 272 articles were included. The review showed a growing number of publications over the years, with 43.0% being published between 2015 and 2018, providing generally positive results (76.8%). The United States was responsible for 38.2% of articles. Cardiovascular disease was the topic of 47.8% of studies, whereas surgical pathologies and postoperative care represented only 2.6%. Wireless devices or smartphone apps were the most popular strategy (75.7%), with 17.6% of studies employing tele-education and 24.6% employing teleconsultation measures. Most publications were OCEBM Level of Evidence 2 (73.5%). Conclusion: Telemonitoring appears to maximize patient care and effectiveness of treatment. The number of publications illustrates the growing interest in the matter. Telemonitoring has yet to be evaluated in the setting of postoperative care and surgical pathologies.

Preoperative Computed Tomography-guided Microcoil Localization for Multiple Small Lung Nodules before Video-assisted Thoracoscopic Surgery

背景与目的肺内多发小结节微创手术的成功与否有赖于术前定位，然而目前缺乏针对肺内多发小结节术前定位的临床研究。本研究旨在与同期肺内单发小结节定位相比，探讨行电视胸腔镜手术（video-assisted thoracoscopic surgery, VATS）术前电子计算机断层扫描（computed tomography, CT）引导下留置微弹簧圈定位肺内多发小结节的临床价值。方法回顾性分析术前行肺内小结节微弹簧圈定位者235例的临床资料。根据结节是否为单发分为：单发结节组184例（single nodule group），多发结节组51例（multiple nodules group）。单发结节组常规方式CT引导下定位，多发结节组在CT引导下分级、分批次留置微弹簧圈定位，统计分析两组定位成功率、并发症、病理结果及定位操作相关数据等。结果多发结节组定位成功率达90.2%，与同期单发结节组成功率相比无统计学差异（90.2% vs 94.6%, P=0.205），多发结节组气胸发生率与单发结节组亦无统计学差异（21.6% vs 14.1%, P=0.179），然而多发结节组的操作时间明显长于单发结节组的操作时间[(30.6±6.6) min vs (19.9±7.4) min, P=0.000]。两组均无大咯血、空气栓塞及血胸发生等严重并发症。两组均无因术中无法定位结节而中转开胸者；手术方式以亚肺叶切除为主；术后病理以非浸润性病变为主。结论对于需行胸腔镜手术的肺部多发小结节，按照一定策略，术前CT引导下分级、分批次留置微弹簧圈的定位方法安全、有效，值得推广。

Is fine needle aspiration biopsy reliable in the diagnosis of parotid tumors? Comparison of preoperative and postoperative results and the factors affecting accuracy

IntroductionFine needle aspiration biopsy is a valuable tool in preoperative evaluation of head and neck tumors. However, its accuracy in management of salivary gland tumors is debatable. ObjectiveWe aimed to investigate the efficacy and the accuracy of fine needle aspiration biopsy in parotid gland tumors. MethodsPatients who underwent parotidectomy between January 2008 and June 2017 due to parotid gland tumor were examined retrospectively. Patients with both preoperative fine needle aspiration biopsy and postoperative surgical pathologies were included. Preoperative fine needle aspiration biopsy was categorized as benign, malignant or suspicious for malignancy. Surgical pathology was grouped as benign or malignant. Surgical pathology was compared with fine needle aspiration biopsy, and sensitivity, specificity, accuracy and agreement between both tests were investigated. Results217 cases were evaluated and 23 cases were excluded because the fine needle aspiration biopsy diagnosis was non-diagnostic or unavailable. 194 cases were included. The mean age of the patients was 47.5±15.88 (7–82). There were 157 benign, 37 malignant cases in fine needle aspiration biopsy, 165 benign and 29 malignant cases in surgical pathology. The most common benign tumor was pleomorphic adenoma (43.3%), and malignant tumor was mucoepidermoid carcinoma (4.13%). The diagnostic accuracy for fine needle aspiration biopsy when detecting malignancy was 86.52%. Sensitivity and specificity were 68.96% and 89.63% respectively. Positive predictive value was 54.05% and negative predictive value was 94.23%. There was moderate agreement between fine needle aspiration biopsy and surgical pathology (κ=0.52). The sensitivity was 54.54% in tumors less than 2cm while 77.77% in larger tumors. In tumors extending to the deep lobe, sensitivity was 80%. ConclusionFine needle aspiration biopsy is an important diagnostic tool for evaluating parotid gland tumors. It is more accurate in detecting benign tumors. In tumors greater than 2cm and extending to the deep lobe, the sensitivity of fine needle aspiration biopsy is high. The use of fine needle aspiration biopsy in conjunction with clinical and radiological evaluation may help to reduce false positive and false negative results.

Are total thyroidectomy and loboisthmectomy effective and safe in benign thyroid diseases? An analysis of 420 patients

Objective. Ideal thyroid surgery is still a debated issue due to preoperative pathology and varying rates of postoperative incidental carcinoma and complications. In our clinic loboisthmectomy and bilateral total thyroidectomy are the treatment of choice in benign nodular thyroid diseases. The objective of this study was to analyse effectiveness and safety of bilateral total thyroidectomy and loboisthmectomy for treating benign thyroid diseases. Methods. Patient charts of the subjects that have undergone thyroid surgery due to benign thyroid diseases between 2009-2015 were evaluated retrospectively. We extracted data including number of patients, type of surgery, preoperative and postoperative pathologies and postoperative complications from departments medical records. Results. Four hundred and twenty patients including 98 (23.3%) male and 322 (76.7%) females aged between 14-80 years (mean; 47.3 ± 12.5) were included into the study. Bilateral total thyroidectomy was performed in 348 (82.9%) patients and loboisthmectomy was performed in 72 (17.1%). Mean duration of follow-up was 41 (range: 15-70) months. Incidental thyroid carcinoma rate was 24.5% (n = 103) in postoperative pathological examination. Temporary and permanent hypocalcemia was seen in 53 (15.2%) patients and 8 (2.3%), respectively. Permanent and transient recurrent laryngeal nerve palsy rate were 2.6% and 2.1%, respectively. Postoperative hematoma was observed in 7 (1.7%) patients. Conclusions. Incidental thyroid carcinoma is frequent in patients who had surgical operation for benign thyroid diseases. When revision surgeries and additional complications due to revision surgery in the remaining cases are kept in mind, bilateral total thyroidectomy or loboisthmectomy at the minimum can be considered as the ideal surgical approach for benign thyroid diseases.