Preop Group Research Articles

Saucerization of complete discoid lateral meniscus is associated with change of morphology of the lateral femoral condyle and tibial plateau.

To determine the effect of saucerization surgery on knee joint morphology associated with a complete discoid lateral meniscus (DLM) using magnetic resonance (MR) imaging. This retrospective study included cases had undergone saucerization surgery for symptomatic DLM between 2007 and 2022. All cases were divided into two by age group: < 12 (U13) and > 13 (O13). The cases in the match group were randomly selected from preoperative cases in the O13 group matched with the age at the final follow-up (F/U) of cases in the U13 group. The following morphological parameters were evaluated using MR images preoperatively and at the final postoperative F/U in each group: anterior obliquity of the lateral tibial plateau (AOLTP), posterior obliquity of the lateral tibial plateau (POLTP), and the lowest point of the lateral femoral condyle (LPLFC). Each parameter was compared between the U13 preoperative (pre-OP) group and the O13 pre-OP group, the preoperative and final follow-up in the U13, and the U13 group at the final F/U and the match group preoperatively. A total of 77 cases were evaluated. 31 cases were in the U13 pre-OP group and 46 were in the O13 pre-OP group. With a minimal F/U of 2years, 27 cases in the U13 group and 36 in the O13 group were included. The mean F/U period was 4.6years in the U13 group and 3.2years in the O13 group. 32 cases were included in the match group. In the match group, the inclination of the POLTP was significantly larger (P = 0.042) and the LPLFC was more lateral (P = 0.0034) than at the final F/U in the U13 group. Saucerization surgery for DLM in juvenile patients can prevent progression to the characteristic bone morphology DLM. These results could help the surgeon making the decision when the surgery would be performed for symptomatic DLM patients. Retrospective comparative study; level of evidence, 3.

Incontinence after fistulotomy in low anal fistula: Can Kegel exercises help improve postoperative incontinence?

AimFistulotomy is the commonest procedure performed for low anal fistulas. The incidence of gas and urge incontinence after fistulotomy and whether Kegel exercises (KE) could help recover sphincter function after fistulotomy has not been studied before. Methods Patients operated by fistulotomy for low fistulas were recommended KE (pelvic contraction exercises) 50 times/day for one year postoperatively. Incontinence (solid, liquid, gas and urge) was evaluated objectively (Vaizeys scores) preoperatively [Pre-op Group], in the immediate postoperative period [Pre-KE Group] and at 6-months follow-up [Post-KE Group]. Incontinence scores in all three groups were compared to evaluate the efficacy of KE. Results101 MRI-documented low anal-fistula patients were included. There were 79 males (mean age 39.412.9 years) and median follow-up was 12 months (6-18months). Two patients were lost to follow-up. Fistulas healed in all the patients. Incontinence was present in 5/99 patients (mean incontinence scores-0.130.63) preoperatively and occurred in 20/99 (mean incontinence scores-1.032.18) patients postoperatively (Pre-KE Group). With KE, the incontinence improved completely in 10 and partially improved in other 10 (mean incontinence scores-0.311.09). Urge and gas incontinence accounted for most cases (80%). The mean incontinence scores deteriorated significantly after fistulotomy (pre-op vs pre-KE, p=0.000059, significant) but continence improved significantly with KE, thus the scores between pre-op and post-KE became comparable (pre-op vs post-KE, p=0.07, not significant).ConclusionsFistulotomy, even in low fistulas, can lead to significant increase in gas and urge incontinence. Regular Kegel exercises postoperatively can help recover lost sphincter function and can bring back continence comparable to preoperative levels.

Quantitative Analysis in Cervical Spinal Cord Injury Patients Using Diffusion Tensor Imaging and Tractography.

ObjectiveTo investigate the clinical usefulness of diffusion tensor imaging (DTI) and tractography in the prediction of outcomes after traumatic cervical spinal cord injury (SCI) and to assess whether the predictability is different between DTI and tractography administered before and after surgery.MethodsSixty-one subjects with traumatic cervical SCI were randomly assigned to preop or postop groups and received DTI accordingly. Among the patients who had DTI before surgery, we assigned 10 patients who had received repeated DTI examinations at 8 weeks after injury to the follow-up group. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were obtained from DTI, and imaginary fiber and crossing fiber numbers were calculated from the tractography. Neurological status and functional status were assessed at 4 and 8 weeks after SCI.ResultsThe neurologic and functional statuses of both groups improved after 4 weeks. Out of the initial 61 patients who were enrolled in the study, the failure rate of DTI image analysis was significantly higher in the postop group (n=17, 41.5%) than in the preop group (n=6, 20%). The FA values and fiber numbers in the preop group tended to be higher than those in the postop group, whereas ADC values were lower in the preop group. When comparing the tractographic findings in the follow-up group, imaginary fiber numbers at the C6 and C7 levels and crossing fiber numbers from the C3 to C6 levels were significantly decreased after surgery. Several DTI and tractographic parameters (especially the ADC value at the C4 level and imaginary fiber numbers at the C6 level) showed significant correlations with neurologic and functional statuses in both the preop and postop groups. These findings were most prominent when DTI and physical examination were simultaneously performed.ConclusionPreoperative DTI and tractography demonstrated better FA and ADC values with lower interpretation failure rates than those obtained after surgery, whereas postoperative data significantly reflected the patient’s clinical state at the time of evaluation. Therefore, DTI and tractography could be useful in predicting clinical outcomes after traumatic cervical SCI and should be interpreted separately before and after spine surgery.

MP22-05 DOES STARTING PELVIC FLOOR PHYSICAL THERAPY PRIOR TO RADICAL PROSTATECTOMY IMPROVE POST-OPERATIVE CONTINENCE RATES?

You have accessJournal of UrologyCME1 May 2022MP22-05 DOES STARTING PELVIC FLOOR PHYSICAL THERAPY PRIOR TO RADICAL PROSTATECTOMY IMPROVE POST-OPERATIVE CONTINENCE RATES? P. Walker Prillaman, Elizabeth Roger, Francescar Monn, Gregoryr Mansour, Jessicar DeLong, Ramonr Virasoro, and Kurtr McCammon P. Walker PrillamanP. Walker Prillaman More articles by this author , Elizabeth RogerElizabeth Roger More articles by this author , Francescar MonnFrancescar Monn More articles by this author , Gregoryr MansourGregoryr Mansour More articles by this author , Jessicar DeLongJessicar DeLong More articles by this author , Ramonr VirasoroRamonr Virasoro More articles by this author , and Kurtr McCammonKurtr McCammon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002561.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A cancer survivorship clinic (CSC) for men undergoing radical prostatectomy (RP) was started in 2010 at our institution to facilitate return of erectile function and urinary continence. In our previous studies we found that men attending a CSC are offered more options for erectile dysfunction, have more rapid return of erectile function, and are more likely to utilize pelvic floor physical therapy (PFPT). This study sought to assess whether starting PFPT prior to RP vs afterward led to improvements in post-operative continence. We hypothesized that starting PFPT pre-op would improve continence rates as patients would have an easier time learning and mastering the exercises. METHODS: A retrospective cohort study of a RP database was conducted of men undergoing surgery between Sept 2014 and Dec 2018. The primary outcomes of interest were incontinence rates based upon pads per day (PPD) at the 1 and 3 month post-op visit and need for incontinence procedure. Patients who had documented follow-up less than 4 months were excluded. Nerve-sparing status was also investigated. RESULTS: 333 men were identified for inclusion. Mean follow-up was 37.0 (SD 19.1) months in the pre-op group and 32.8 (SD 16.4) months in the post-op group. Patient age and BMI were comparable between cohorts (p-value 0.12, 0.11, respectively). The rate of nerve-sparing status was not statistically different with a p-value of 0.23. The cohorts were similar in regard to tobacco use, DM, MI, and stroke. At the 1-month mark there was a decreased number of PPD in the pre-op group at 2.35 (SD 0.97) vs 2.91 (SD 2.63), however it was not significant with a p-value of 0.13. At the 3-month mark, there was a statistically significant decrease in PPD at 0.97 (SD 1.46) vs 1.49 (SD 1.60) with a p-value of 0.04. The likelihood of undergoing an incontinence procedure within 60 months of surgery was not different with an odds ratio of 0.37 (CI 0.07-1.91). CONCLUSIONS: Beginning PFPT prior to surgery is associated with decreased PPD at the 3-month post-op mark. This is expected as men that learn exercises prior to surgery will have an easier time mastering them compared to those who learn while still recovering from surgery. Starting therapy before surgery did not have an impact on undergoing an incontinence procedure. This study suggests early improvement in incontinence if therapy is started pre-op, which should be encouraged. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e373 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information P. Walker Prillaman More articles by this author Elizabeth Roger More articles by this author Francescar Monn More articles by this author Gregoryr Mansour More articles by this author Jessicar DeLong More articles by this author Ramonr Virasoro More articles by this author Kurtr McCammon More articles by this author Expand All Advertisement PDF DownloadLoading ...

Effect of Carbohydrate-Enriched Drink Compared to Fasting on Hemodynamics in Healthy Volunteers. A Randomized Trial.

Fasting prior to surgery can cause dehydration and alter hemodynamics. This study aimed to determine the impact of a carbohydrate-enriched drink (NutriciaTM Pre-op®) on selected hemodynamical parameters, measured in a non-invasive manner. We enrolled 100 healthy volunteers and measured their weight, height, systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), thoracic fluid content (TFC), thoracic fluid index (TFCI), stroke volume (SV), stroke volume variation (SVV), stroke index (SI), cardiac output (CO), cardiac index (CI), heather index (HI), systolic time ration (STR), systemic time ratio index (STRI), systemic vascular resistance (SVR), and systemic vascular resistance index (SVRI) by a Niccomo™ device, implementing the impedance cardiography (ICG) method. Measurements were performed at the beginning of the study, and after 10 h and 12 h. We randomly allocated participants to the control group and the pre-op group. The pre-op group received 400 mL of Nutricia™ preOp®, as suggested in the ERAS guidelines, within 10 h of the study. Student’s t-test or the Mann–Whitney U test were used to compare the two groups, and p < 0.05 was considered significant. We did not observe any changes in hemodynamical parameters, blood pressure, and heart rate between the groups. We have proven that carbohydrate-enriched drink administration did not have a significant impact on the hemodynamical parameters of healthy volunteers.

The influence of fasting and carbohydrate-enriched drink administration on body water amount and distribution: a volunteer randomized study

BackgroundFasting prior to anesthesia is considered aspiration prophylaxis. However, prolonged food and drink restrictions may increase the risk of other complications. The aim of this study was to assess whether a carbohydrate-enriched drink (Nutricia™ preOp®), recommended by the enhanced recovery after surgery (ERAS) protocol, can improve body hydration in fasting healthy individuals.MethodsMeasurements were done with the bioelectric impedance analysis with a Fresenius body composition monitor. Body composition, total body water, water distribution, and hemodynamic parameters were measured at the beginning of the study and after 10 h and 12 h of fasting. Patients fasted for 10 h and then were divided into two groups: the control (n = 40) and the pre-op group (n = 41). The pre-op group received 400 mL of Nutricia™ preOp®, as suggested in the ERAS guidance. The two-tailed Student’s t test was used to compare two groups with normally distributed data and homogenous variances; if variances were heterogeneous, Welch’s test was used. The Mann-Whitney U test was used to compare two groups with non-normal data distribution. p < 0.05 was considered statistically significant.ResultsWe found no significant differences between the control and pre-op groups regarding body water distribution and body composition. We did not observe significant losses in the total body water after fasting. Also, blood pressure was not affected by fasting.ConclusionWe have proven that pre-op did not impact either body composition or body water.Trial registrationClinicalTrials.gov, NCT04665349. Registered on 11 December 2020—retrospectively registered.

Altered methylarginine levels after surgery in subjects with multinodular goiter.

Thyroid disorders are important risk factor for cardiovascular diseases. Levels of methylarginines such as asymmetric dimethyl arginine (ADMA), L-monomethyl arginine (L-NMMA), symmetric dimethyl arginine (SDMA) are increase in cardiovascular diseases. Multinodular goiter (MNG) is the most common type of goiter in adults. To date, no study has been conducted to determine the levels of methylarginine in euthyroid MNG patients. Our aim in this study is to compare levels of methylarginines and related metabolites in the preoperative, postoperative MNG patients and controls. Serum ADMA, SDMA, L-NMMA, homoarginine (hArg), arginine and citrulline concentrations were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS). ADMA (p<0.001), L-NMMA (p=0.002), l-arginine (p=0.006) and citrulline (p<0.001) levels were statistically significantly higher in preop group than postop group. ADMA (p=0.003), L-NMMA (p=0.003) levels were statistically significantly higher and SDMA/ADMA (p<0.001), hArg/ADMA (p<0.001) levels were statistically significantly lower in preop group than control group. The levels of methylarginines and related metabolites altered in the euthyroid MNG patients compared to the control group, and more importantly, there were significant differences between the preop and postop groups. Therefore, these metabolites can be useful in the diagnosis and prognosis of thyroid disorders, even if thyroid hormone levels are normal.

Feasibility study on pre or postoperative accelerated radiotherapy (POP-ART) in breast cancer patients

BackgroundIn early-stage breast cancer, the cornerstone of treatment is surgery. After breast-conserving surgery, adjuvant radiotherapy has shown to improve locoregional control and overall survival rates. The use of breast radiotherapy in the preoperative (preop) setting is far less common. Nevertheless, it might improve disease-free survival as compared to postoperative radiotherapy. There is also a possibility of downsizing the tumour which might lead to a lower need for mastectomy. There are some obstacles that complicate its introduction into daily practice. It may complicate surgery or lead to an increase in wound complications or delayed wound healing. Another fear of preop radiotherapy is delaying surgery for too long. At Ghent University Hospital, we have experience with a 5-fraction radiotherapy schedule allowing radiotherapy delivery in a very short time span.MethodsTwenty female breast cancer patients with non-metastatic disease receiving preop chemotherapy will be randomized between preop or postoperative radiotherapy. The feasibility of preop radiotherapy will be evaluated based on overall treatment time. All patients will be treated in 5 fractions of 5.7 Gy to the whole breast with a simultaneous integrated boost to the tumour/tumour bed of 5 × 6.2 Gy. In case of lymph node irradiation, the lymph node regions will receive a dose of 27 Gy in 5 fractions of 5.4 Gy. The total duration of therapy will be 10 to 12 days. In the preop group, overall treatment time is defined as the time between diagnosis and the day of last surgery, in the postop group between diagnosis and last irradiation fraction. Toxicity related to surgery, radio-, and chemotherapy will be evaluated on dedicated case-report forms at predefined time points. Tumour response will be evaluated on the pathology report and on MRI at baseline and in the interval between chemotherapy and surgery.DiscussionThe primary objective of the trial is to investigate the feasibility of preop radiotherapy. Secondary objectives are to search for biomarkers of response and toxicity and identify the involved cell death mechanisms and the effect of preop breast radiotherapy on the in-situ immune micro-environment.

Parental fatigue before and after ventilation tube insertion in their children.

To determine if there is a difference in fatigue for caregivers of children with otitis media pre and post ventilation tube insertion (VTI). Consecutive parents presenting with children at a pediatric otolaryngology practice at an academic medical center with recurrent otitis media who met criteria for VTI or who were following up within 6weeks of VTI were surveyed with the Chalder Fatigue Scale (CFQ), a Visual Analogue Fatigue Scale (VAS-F), and demographic questions. No significant demographic differences were found (P<0.05) in the preop versus postop groups. 101 parents participated, 88 mothers and 13 fathers. 59.4% were married or cohabitating, 18.8% were single, 10.9% were divorced, and 10.9% declined to answer. 45.5% were aged 18-29years, 50.1% were 30-39years, 2.9% were 40+ years, 1.0% declined to answer. 53.0% were college graduates. 46 (45.5%) were preop and 55 (54.5%) were postop. There were no statistical differences between these groups for age, gender, marital status, education level or number or children in the household. Mean VAS-F, with 0 being worst fatigue and 10 being normal, was 5.256 in the preop group and 6.777 in the postop group (p<0.001). Mean CFQ, with higher numbers meaning worse fatigue, was 15.749 in the preop group and 11.804 in the postop group (p=0.002). Parental fatigue can have significant effects on the family. Fatigue in parents whose children have otitis media has not been previously described. VTI for recurrent otitis media in children is associated with improved fatigue in their parents.

532PD - Pre-operative FOLFOX chemotherapy in advanced colon cancer: Pathology analysis of the FOxTROT trial

BackgroundThe phase III international FOxTROT trial assessed the effectiveness of pre-operative chemotherapy in locally advanced colon cancer. Patients were randomised across 85 centres to pre- and post-operative FOLFOX-based chemotherapy (pre-op) or to post-operative FOLFOX chemotherapy alone (post-op) in a 2:1 ratio. MethodsCentral pathological review was performed on scanned H&E stained slides in 904 out of 1,052 cases (86%) to include reassessment of the core pathology endpoints and an additional assessment of novel prognostic and immunological markers according to trial arm. ResultsThe pre-op group showed a lower pT stage (pT0-pT2 rate 18% vs 8%, p<0.0001), lower pN stage (pN0 rate 64% vs. 52%, p=0.0002), smaller tumour diameter (40mm vs. 51mm, p<0.0001), and greater R0 rate (99% vs. 96%, p=0.02). The pre-op group showed a lower rate of apical node metastases (3% vs. 8%, p=0.002), extracapsular spread (8% vs. 19%, p<0.0001), intramural venous invasion (20% vs. 33%, p<0.0001), extramural venous invasion (35% vs. 44%, p=0.004) and lymphatic invasion (46% vs. 55%, p=0.002). The percentage of the patients with high-grade tumour budding was lower in pre-op group (5% vs. 14%, p<0.0001). Significantly greater numbers of stromal tumour infiltrating lymphocytes (TILs) (14% vs. 9%, p<0.0001) and eosinophils (6% vs. 3%, p<0.0001) were observed in the pre-op group, however, intratumoural TILs were equivalent (5% vs. 5%, p=0.63). Significantly lower numbers of neutrophils (5% vs. 10%, p<0.0001) and reduced abscess formation (11% vs. 21%, p<0.0001) was seen in the pre-op group. The average area of all uninvolved lymph nodes was smaller in the preoperative group as was the average tumour area in metastatic nodes. ConclusionsPre-op chemotherapy in locally advanced colon cancer is associated with a significant reduction in many high-risk pathological features and potential mechanisms of metastatic spread. There is also a clear effect on tumour immunology. The association with 2 year DFS is currently being performed and will be presented at the meeting. Legal entity responsible for the studyUniversity of Birmingham. FundingAmgen. DisclosureAll authors have declared no conflicts of interest.

RADI-12. LEPTOMENINGEAL FAILURE AFTER PREOPERATIVE VERSUS POSTOPERATIVE RADIOSURGERY

INTRODUCTION: Postoperative stereotactic radiosurgery (postop SRS) is potentially complicated by difficulty defining the target volume and the risk of leptomeningeal seeding at the time of surgery. It is hypothesized that preop SRS may render cells less viable to disseminate in the leptomeningeal space. This retrospective study compares the leptomeningeal dissemination (LMD) rate for preop versus postop radiosurgery METHODS: We identified 140 patients with brain metastases who underwent resection and radiosurgery at the University of Alabama at Birmingham including 91 postop patients (2005–2015) and 49 preop patients (2011–2018). The preop group included 19 patients enrolled in a phase I trial of preoperative radiosurgery (12–15 Gy) for tumors 2–6 cm in greatest diameter. In that study 15 Gy was found to be safe in the preop setting but further escalation was not attempted. An additional 30 patients received preop SRS off-study (median dose 15 Gy). The median postop dose was 16 Gy. LMD recurrence was defined as focal pachymeningeal or diffuse leptomeningeal enhancement of the brain, spinal cord, or cauda equina, dural enhancement beyond 5 mm from the index metastasis, subependymal enhancement, or enhancement of cranial nerves. This definition is not limited to carcinomatosis. All events were categorized and confirmed by at least two physicians. RESULTS: 40/140 (29%) patients developed new focal or diffuse LMD. Preop SRS was associated with a higher freedom from leptomeningeal recurrence (84% vs 60% at one year, p=0.021 Breslow, p=0.128 log-rank). Since later LMD may not be related to surgery, a second analysis censoring follow-up at one year was performed and confirmed this trend (p=0.008 Breslow, p=0.014 log-rank). CONCLUSIONS: Preoperative SRS is associated with a reduction in the risk of LMD compared to postop SRS. Focal pachymeningeal dissemination may not always be recognized as related to surgery. A randomized trial of preop vs postop SRS is warranted.

Granulocyte-colony stimulating factor enhances bone fracture healing

BackgroundCirculating mesenchymal stem cells contribute to bone repair. Their incorporation in fracture callus is correlated to their bioavailability. In addition, Granulocyte-colony stimulating factor induces the release of vascular and mesenchymal progenitors. We hypothesized that this glycoprotein stimulates fracture healing, and analyzed the effects of its administration at low doses on bone healing. Methods27 adult male Sprague-Dawley rats underwent mid-femur osteotomy stabilized by centromedullar pinning. In a post (pre) operative group, rats were subcutaneously injected with 5 μg/kg per day of Granulocyte-colony stimulating factor for 5 days after (before) surgery. In a control group, rats were injected with saline solution for 5 days immediately after surgery. A radiographic consolidation score was calculated. At day 35, femurs were studied histologically and underwent biomechanical tests. Findings5 weeks after surgery, mean radiographic scores were significantly higher in the Preop group 7.75 (SD 0.42) and in the Postop group 7.67 (SD 0.52) than in the control group 6.75 (SD 0.69). Biomechanical tests showed femur stiffness to be more than three times higher in both the Preop 109.24 N/mm (SD 51.86) and Postop groups 100.05 N/mm (SD 60.24) than in control 32.01 N/mm (SD 15.78). Mean maximal failure force was twice as high in the Preop group 68.66 N (SD 27.78) as in the control group 34.21 N (SD 11.79). Histological results indicated a later consolidation process in control than in treated groups. InterpretationGranulocyte-colony stimulating factor injections strongly stimulated early femur fracture healing, indicating its potential utility in human clinical situations such as programmed osteotomy and fracture.

Evaluation of the anatomic and hemodynamic abnormalities in tricuspid atresia before and after surgery using computational fluid dynamics.

Analysis of hemodynamics inside tricuspid atresia (TA) chamber is essential to the understanding of TA for optimal treatment. In this study, we introduced a combined computational fluid dynamics (CFD) to simulate blood flow in the left ventricle (LV) to study the diastolic flow changes in TA.Real-time 3-dimentional echocardiography loops (ECHO) were acquired in normal control group, in TA patients before surgery (pre-op group) and after surgery (post-op group). ECHO loops were reconstructed and simulated by CFD, the geometric, volumetric changes, and vortices in the LV were studies and compare among 3 groups.Compared with the control group, pre-op TA patients demonstrated significant LV remodeling, manifesting with smaller LV length, larger diameter, width and spherical index, as well as lager volumes; post-op TA group showed revisions in values of both geometric and volumetric measurements. CDF also demonstrated the abnormality of vortices in the pre-op TA patients and the alteration of existence and measurements of vortex in postoperation group.Echo-based CFD modeling can show the abnormality of TA in both LV geometric, volumetric measurements and intracardiac vortices; and CFD is capable to demonstrate the alterations of LV after Fontan and Glenn surgical procedure.

Effects of preoperative carbohydrate drinks on postoperative outcome after colorectal surgery

Overnight fasting before surgery used to be the routine. Overnight fasting changes patients’ metabolic state and influences their perioperative stress response. The aim of the study was to investigate the effects of preoperative carbohydrate drinks on return of bowel sounds and movement, postoperative complications, and length of stay. It is a prospective non-randomized study with 196 consecutive patients who underwent surgery in Vsetin hospital for a diagnosis of colon or rectal cancer from January 2010 to January 2015. Patients were assigned into two groups – with (PreOp group) and without (Non-PreOp group) carbohydrate drink. We collected data regarding age, comorbidities, local stage of tumor, urgency and type of operation. The output variables recorded included postoperative bowel sounds, first stool, postoperative complications, anastomotic leak, surgical site infections, and length of hospital stay. In the PreOp group there was faster return of peristalsis (p = 0,033). We did not prove that the PreOp influenced passage of stool. The total number of postoperative complications was higher in the Non-PreOp group than in the PreOp group, 57 (57%) vs. 30 (31%) respectively, (p = 0,0003). The most frequent type of complication was surgical site infection (SSI). It occurred in 17% in the PreOp group and in 34% in the Non-PreOp group (p = 0,004). The difference in anastomotic leak rate was not significant. Mean hospital stay was 13 days in the PreOp group and 16 days in the Non-PreOp group (p = 0,006). Use of carbohydrate solution before the surgery accelerates return of bowel sounds, reduces total number of postoperative complications, SSI and shortens the length of hospital stay. Carbohydrate beverages should be used more widely in daily practice.

Fluoroquinolones Impair Tendon Healing in a Rat Rotator Cuff Repair Model

Background: Recent studies suggest that fluoroquinolone antibiotics predispose tendons to tendinopathy and/or rupture. However, no investigations on the reparative capacity of tendons exposed to fluoroquinolones have been conducted. Hypothesis: Fluoroquinolone-treated animals will have inferior biochemical, histological, and biomechanical properties at the healing tendon-bone enthesis compared with controls. Study Design: Controlled laboratory study. Methods: Ninety-two rats underwent rotator cuff repair and were randomly assigned to 1 of 4 groups: (1) preoperative (Preop), whereby animals received fleroxacin for 1 week preoperatively; (2) pre- and postoperative (Pre/Postop), whereby animals received fleroxacin for 1 week preoperatively and for 2 weeks postoperatively; (3) postoperative (Postop), whereby animals received fleroxacin for 2 weeks postoperatively; and (4) control, whereby animals received vehicle for 1 week preoperatively and for 2 weeks postoperatively. Rats were euthanized at 2 weeks postoperatively for biochemical, histological, and biomechanical analysis. All data were expressed as mean ± standard error of the mean (SEM). Statistical comparisons were performed using either 1-way or 2-way ANOVA, with P < .05 considered significant. Results: Reverse transcriptase quantitative polymerase chain reaction (RTqPCR) analysis revealed a 30-fold increase in expression of matrix metalloproteinase (MMP)-3, a 7-fold increase in MMP-13, and a 4-fold increase in tissue inhibitor of metalloproteinases (TIMP)-1 in the Pre/Postop group compared with the other groups. The appearance of the healing enthesis in all treated animals was qualitatively different than that in controls. The tendons were friable and atrophic. All 3 treated groups showed significantly less fibrocartilage and poorly organized collagen at the healing enthesis compared with control animals. There was a significant difference in the mode of failure, with treated animals demonstrating an intrasubstance failure of the supraspinatus tendon during testing. In contrast, only 1 of 10 control samples failed within the tendon substance. The healing enthesis of the Pre/Postop group displayed significantly reduced ultimate load to failure compared with the Preop, Postop, and control groups. There was no significant difference in load to failure in the Preop group compared with the Postop group. Pre/Postop animals demonstrated significantly reduced cross-sectional area compared with the Postop and control groups. There was also a significant reduction in area between the Preop and control groups. Conclusion: In this preliminary study, fluoroquinolone treatment negatively influenced tendon healing. Clinical Relevance: These findings indicate that there was an active but inadequate repair response that has potential clinical implications for patients who are exposed to fluoroquinolones before tendon repair surgery.

Preoperative oral carbohydrate improved postoperative insulin resistance in rats through the PI3K/AKT/mTOR pathway.

BackgroundPreoperative oral carbohydrate (OCH) improves postoperative insulin resistance (PIR) and insulin sensitivity. However, the exact mechanisms involved in the improvement of PIR with respect to preoperative OCH are still not clear. The aim of this study was to investigate the involvement of preoperative OCH and PI3K/AKT/mTOR pathway in reducing PIR in rats.Material/MethodsForty male Sprague-Dawley rats were randomly assigned to PreOp, glucose, saline, and fasting groups. Rats in the PreOp, glucose, and saline groups received OCH, 5% glucose solution, and saline, respectively. Rats in the fasting group did not receive anything but were fasted 3 h before surgery. Blood glucose, insulin and leucine levels, and insulin resistance, secretion, and sensitivity indexes were measured before and after surgery. mRNA and protein (total and phosphorylated) levels of mTOR, IRS-1, PI3K, PKB/AKT, and GlUT4 were measured using real-time polymerase chain reaction and Western blot in skeletal muscles.ResultsIn the PIR experiment, blood glucose, serum insulin, insulin resistance, and serum leucine levels were all significantly lower in the PreOp group than in the other 3 groups (P<0.05) after surgery. HOMA-ISI were higher in the PreOp group vs the other 3 groups after surgery (P<0.05), and HOMA-β in the PreOp group was higher than that in the other 3 groups at 30 and 120 min after surgery. Additionally, post-operative phosphorylated IRS-1, PI3K, and AKT protein levels were significantly higher in the PreOp group than in the other 3 groups (P<0.05), but no significant differences were observed in their respective protein levels (P>0.05).ConclusionsOCH decreases postoperative insulin resistance and improves postoperative insulin sensitivity in skeletal muscles through the PI3K/AKT/mTOR pathway.

Parenteral Nutrition and preOp preparation in prevention of post-operative insulin resistance in gastrointestinal carcinoma

The aim was to compare preventive effect of total parenteral nutrition (TPN) and oral nutrition (preOp) on the perioperative insulin resistance prevention in surgical gastrointestinal cancer patients. The study was conducted in a group of 75 elective gastric and large intestine cancer patients. Patients were randomly divided into 3 study groups, 25 patients each: group I (NIL) - no preparations influencing tissue sensitivity to insulin, group II (TPN) - total parenteral nutrition in its preoperative stage and group III (TPN + preOp) parenteral nutrition and preOp in the preoperative phase. Immediately after the surgery, no statistically significant differences in insulin resistance level between groups were observed. During the first 6 postoperative hours, a statistically significant decrease of insulin resistance level in the TPN+ preOp group in comparison to others, was observed. During the first 24 postoperative hours, the NIL group was the only one to keep the insulin resistance level the same as in the preoperative phase. Application of TPN in the preoperative phase leads to shortening of perioperative insulin resistance time. Combining TPN with oral application of carbohydrate before surgical procedure is an effective and the best method in postoperative insulin resistance syndrome prevention.

Evaluation of oxidative stress and DNA damage in benign prostatic hyperplasia patients and comparison with controls.

In the present study, oxidative stress and lymphocytic DNA damage in both pre-op and post-op benign prostrate hyperplasia (BPH) patients with age >50years was evaluated and compared with normal healthy subjects (controls- without any evidence of disease) of the same sex and age group. From December 2007 to November 2009, oxidative stress in 45 BPH patients were evaluated both before (pre-op patients) and after 7days of surgery (post-op patients) in terms of measurements of plasma levels of (1) various anti-oxidative enzymes, (2) non-enzymatic antioxidants and (3) malondialdehyde which is a product of lipid peroxidation. The lymphocyte DNA damage was also evaluated by single cell alkaline gel electrophoresis in terms of tail length migration in these patients. These values were compared with their respective control subjects of similar sex and age group. The activities of antioxidant enzymes and the levels of antioxidant, reduced glutathione were found significantly decreased (p<0.05) in serum samples of pre-operative group of BPH patients as compared to the controls. These altered parameters increased significantly (p<0.05) and returned to their near normal control values, but not up to baseline values, in post operative patients i.e. after the cancer load was decreased by surgery. Lymphocytic DNA damage was found to be significantly increased in pre-op group as compared to controls and was reduced after surgery in post-op group. The present study therefore, shows significantly increased levels of oxidative stress and DNA damage in BPH patients which were reduced after removal of tumour load. Thus oxidative damage plays an important role in prostate tumourogenesis and timely management of oxidative stress can be of importance in preventing the occurrence of BPH.

Detection of Sentinel Nodes in Gastric Cancer by Indocyanine Fluorescence Imaging

The sentinel nodes (SN) are the first nodes to receive lymphatic drainage from a primary tumor. The SN concept is useful to avoid unnecessary resection in gastric cancer. Indocyanine green (ICG) fluorescence imaging is a new method for detecting SN and we herein examined the usefulness of this technology. The subjects comprised 39 cT1-2N0 gastric cancer patients who underwent standard surgery from 2006 to 2009. 0.8 mL ICG (1%) was injected into the submucosa around the tumor two days preoperatively (Preop group) or intraoperatively (Intraop group) by endoscopy. SN were postoperatively identified by fluorescence imaging and the accuracy of this method compared to the dye method was investigated for 76 patients treated from 2000-2004. SN was detected as fluorescence-positive nodes (FN) and the mean FN number was 9.3±6.4. The specificity was 100% and all metastatic lymph nodes were detected as FN in three patients. The mean number of FNs was 7.2 in the preop group and 12.5 in the postop group (p=0.032).The FN method was associated with a low false negative rate, same as the dye method. SN mapping using ICG fluorescence imaging has high accuracy and this compound can be injected preoperatively to detect SN.

Double Prophylaxis for Deep Venous Thrombosis in Patients With Gynecologic Oncology Who Are Undergoing Laparotomy

Double prophylaxis for deep venous thrombosis (DVT) with thromboprophylaxis plus sequential compression devices (SCDs) is recommended for high-risk surgical patients with gynecologic oncology. Despite the use of preoperative thromboprophylaxis in clinical trials, the schedule of perioperative low molecular-weight heparin varies widely. We sought to determine the effectiveness and adverse effects of a preoperative dose of anticoagulation in patients with gynecologic oncology. A multi-institutional chart review from January 2006 to July 2008 was performed. Patients with gynecologic oncology who received double prophylaxis for laparotomy were eligible. The patients were grouped according to whether they received preoperative anticoagulation (YES PREOP vs NO PREOP). All patients received postoperative low molecular-weight heparin for thromboprophylaxis and SCDs until discharge. Demographic, surgicopathologic, and complication data were collected. A total of 239 patients were identified: YES PREOP (n = 101) and NO PREOP (n = 138). Groups were similar with respect to demographics, diagnosis, and length of hospital stay. There were 2 DVTs in the YES PREOP group compared with 11 in the NO PREOP group (P = 0.04; relative risk, 0.77). There were also fewer DVT-attributable deaths in the YES PREOP group (0 vs 2; P < 0.001). Postoperative hematocrit (30.2% vs 31.4%; P = 0.42) and number of transfusions (26 vs 14; P = 0.31) were similar. The use of preoperative anticoagulation seems to significantly decrease the risk of DVT in this patient population, and complication rates are not increased. Patients receiving double prophylaxis should receive a preoperative dose of anticoagulation for maximum benefit.