Preoperative Biochemical Tests Research Articles

Microbiology, Treatment, and Postoperative Outcomes of Gram-Negative Prosthetic Joint Infections-A Systematic Review of the Literature.

Gram-negative prosthetic joint infections (PJIs) represent 10% to 25% of all PJIs and are associated with worse outcomes than gram-positive infections. We sought to assess the microbiology, surgical treatment, and outcomes of patients with gram-negative PJIs. A systematic review using the PubMed and Embase databases was conducted. Our study was conducted following the PRISMA guidelines. Included studies were assessed for quality using the STROBE checklist. The primary outcome of analysis was treatment failure. A total of 593 patients with gram-negative PJIs were included. Two-year survival free of treatment failure for hip and knee PJIs was 66% and 68% for acute infections, 39% and 78% for acute hematogenous infections, and 75% and 63% for chronic infections, respectively. Two-year survival free of treatment failure for acute infections treated with débridement, antibiotics, and implant retention was 65% and 67% for hip and knee PJIs, respectively. Exchange of the polyethylene during débridement, antibiotics, and implant retention was associated with higher treatment success (P = 0.045). Chronic PJIs treated with two-stage revision had a two-year treatment success rate of 87% and 65% for the hip and knee, respectively. Risk factors of treatment failure were chronic obstructive pulmonary disease and C-reactive protein ≥30 mg/L in acute PJIs and female sex, knee infection, and previously revised implant in chronic PJIs. Acute PJIs caused by Pseudomonas spp. were associated with lower treatment failure rates. Gram-negative PJIs are associated with a high treatment failure rate. Patient comorbidities, preoperative biochemical tests, microorganism etiology, and PJI characteristics affected the treatment success rate.

Pheochromocytoma with no Evidence of Catecholamine Hypersecretion in Preoperative Biochemical Tests—A Case Report—

Pheochromocytoma with no Evidence of Catecholamine Hypersecretion in Preoperative Biochemical Tests—A Case Report—

The Duration of Preoperative Administration of Single α-Receptor Blocker Phenoxybenzamine before Adrenalectomy for Pheochromocytoma: 18 Years of Clinical Experience from Nationwide High-Volume Center.

Purpose There is no consensus for the optimum duration of preoperative administration of phenoxybenzamine (PXB) before adrenalectomy for pheochromocytoma. The aim of this study is to investigate whether perioperative hemodynamics and postoperative outcomes are related to the duration of PXB administration. Methods In total, 102 patients managed preoperatively with single α-receptor blocker phenoxybenzamine were enrolled from 469 consecutive patients diagnosed histologically with pheochromocytoma. The patients received surgical treatment in the Department of Urology, Peking University First Hospital, between January 2001 and July 2018. All patients were divided into three groups: Group A (<14 d), Group B (14–30 d), and Group C (>30 d). Patient and tumor characteristics, intraoperative hemodynamics, and postoperative outcomes were recorded and compared among the three groups. Results These patients included 47 men and 55 women, with an average age of 43 years at the time of surgery. Clinical characteristics, except the status of preoperative biochemical tests (24 hr urine fractioned catecholamine or plasma-fractioned catecholamine) (p=0.020), preoperative hemodynamics, and medicine management and surgical approaches, in the three groups were comparable. Multivariate analyses demonstrated that the size of the tumor (p=0.034) was an independent risk factor for intraoperative hemodynamic instability. Among the three groups, we found no significant difference in intraoperative hemodynamics and postoperative outcomes. Conclusion The data from the current study indicated that the preoperative management of pheochromocytoma with single α-receptor blocker PXB for more than 2 weeks, after the final dose adjustment, could not further reduce the risk of intraoperative hemodynamic instability or postoperative complications. Thus, our study supports that 14 days would be enough for the duration of preoperative management of pheochromocytoma with single α-receptor blocker PXB in final dose.

Can we predict expected adenoma weight preoperatively with reference to the correlation of preoperative biochemical tests with parathyroid adenoma weight?

Primary hyperparathyroidism is a prevalent disease with proven benefits for appropriately selected patients who undergo parathyroidectomy. The ability to accurately predict expected single adenoma gland weight as the cause based on preoperative biochemical tests could improve cure rates in a minimally invasive approach. To assess the correlation between parathyroid weight and preoperative parathyroid hormone and calcium levels in patients with primary hyperparathyroidism with a solitary adenoma and determine if these could be used to predict expected parathyroid weight. Patients with primary hyperparathyroidism who underwent curative parathyroidectomy from 2013 to 2018 was retrospectively analysed. There is a strong positive correlation r=0.602 between preoperative PTH levels with respect to parathyroid weight (p<0.001). There was a moderate correlation r=0.474 between preoperative adjusted Calcium and PTH weight (p<0.001). An algorithm was developed to calculate predicted weight of a single adenoma but when tested against cases with hyperplasia and double adenomas during the period, the variability of predicted weight meant it was impossible to differentiate between the causes. Hyperplasia was excluded and 95% of double adenomas excluded however, when parathyroid weight exceeded 1200mg CONCLUSION: There is a strong correlation between preoperative PTH levels and calcium levels with parathyroid weight. The large variability of predicted parathyroid weight however, precludes the use of biochemical tests alone preoperatively in being able to differentiate between a single adenoma, double adenoma or hyperplasia as the cause in primary hyperparathyroidism. At parathyroid predicted weights above 1200mg however, all cases of hyperplasia, and 95% of double adenomas excluded.

A retrospective study on risk factors associated with postoperative delirium in elderly patients with hip fracture

Objective To investigate the incidence and related risk factors of delirium in elderly patients with hip fracture. Methods From October 2014 to February 2017, 306 patients with femoral neck fracture or intertrochanteric fracture more than 65 years old underwent elective hip arthroplasty (hip arthroplasty, proximal femoral nail fixation) were retrospectively analyzed. Patients' general information was recorded: age, sex, body mass index (BMI), history of diabetes mellitus, history of coronary heart disease, cerebral infarction, preoperative biochemical tests, left ventricular ejection fraction, thrombosis of both lower extremities, intraoperative status (ASA score, NYHA heart function score, anesthesia, anesthesia time, etc.), perioperative blood transfusion, biochemical examination on the first day after surgery, perioperative albumin consumption, etc.; according to whether delirium happened after surgery, those patients were divided into delirium group and non-delirium Group and analyzed the incidence of postoperative delirium. Using univariate logistic regression analysis screened factors associated with postoperative delirium. The results were entered into the multivariate logistic regression analysis, screening the high risk factors for postoperative delirium. Results The incidence of delirium was 59(19.29%) after perioperative hip fracture, including 23 males and 36 females, ranging in age from 70 to 93 years with an average of (81.9±5.4) years. 247 cases had no delirium, including 81 males and 166 females, aged 65-96 years, with an average (76.4±8.1) years. The factors of age, length of hospital stay, days before surgery, preoperative hematocrit, perioperative albumin consumption, perioperative blood transfusion, preoperative leukocyte levels, preoperative albumin levels, preoperative creatinine, urea level, Mallampati classification (Markov grade), cardiac function score (NYHA score), ASA score, intraoperative blood loss, postoperative leukocyte level, left ventricular ejection fraction, previous cerebral infarction, history of coronary heart disease, and diabetes were statistically significant different; univariate logistic regression analysis showed that the factors of age, ASA score, history of diabetes mellitus, length of hospitalization, and perioperative albumin consumption were demonstrated to have relationship with the occurrence of postoperative delirium. Multivariate regression analysis showed that age, history of diabetes and ASA score are the high risk factors of postoperative delirium. Conclusion Age, history of diabetes mellitus and ASA score are risk factors of delirium in elderly patients with hip fracture. Those patients older than 75 years, with the history of diabetes mellitus or ASA score > 2 points were at higher risk of postoperative delirium, which prolongs hospitalization and increases protein consumption. Key words: Hip fractures; Aged; Delirium; Risk factors; Logistic models

The correlation between plasma osmolarity and tear osmolarity.

To the correlation between plasma osmolarity (Posm) and tear osmolarity (Tosm) in patients (54 patients, 88 eyes) who underwent cataract surgery was evaluated. Before cataract surgery, routine pre-operative biochemical tests were performed, and Posm was determined from blood samples. Also, Tosm was measured using the TearLab system, and objective signs including tear break-up time (BUT), fluorescein staining, lissamine green staining, and Schirmer's test were evaluated. Dry eye (DE) was diagnosed according to the Japanese criteria for DE. Of the 88 eyes, 4 were diagnosed as definite DE, 70 as probable DE, and 14 as normal. Since the number of definite DE was small, the eyes were divided into two groups: normal group (n=14) and DE group (n=74), which included definite DE (n=4) and probable DE (n=70). There was no correlation between Posm and Tosm, though Posm (293.32 mOsm/L) was significantly higher than Tosm (288.48 mOsm/L; p< 0.001). There was no significant difference in Tosm between the normal group (288.29 mOsm/L) and the DE group (288.51 mOsm/L). No patients had a Tosm higher than 310 mOsm/L even in the DE group. Correlations between Posm/Tosm and each DE sign value were not found. Of 54 patients, 18 were diabetic. Posm was significantly higher in diabetic (295.78 mOsm/L) than in non-diabetic (292.36 mOsm/L; p= 0.014) patients, while there was no significant difference in Tosm between diabetic and non-diabetic patients. The results suggest that Tosm is independent of Posm, and Tosm elevation in DE occurs by some local mechanisms.

Liver reserve function assessment by acoustic radiation force impulse imaging.

To evaluate the utility of liver reserve function by acoustic radiation force impulse (ARFI) imaging in patients with liver tumors. Seventy-six patients with liver tumors were enrolled in this study. Serum biochemical indexes, such as aminotransferase (ALT), aspartate aminotransferase (AST), serum albumin (ALB), total bilirubin (T-Bil), and other indicators were observed. Liver stiffness (LS) was measured by ARFI imaging, measurements were repeated 10 times, and the average value of the results was taken as the final LS value. Indocyanine green (ICG) retention was performed, and ICG-K and ICG-R15 were recorded. Child-Pugh (CP) scores were carried out based on patient's preoperative biochemical tests and physical condition. Correlations among CP scores, ICG-R15, ICG-K and LS values were observed and analyzed using either the Pearson correlation coefficient or the Spearman rank correlation coefficient. Kruskal-Wallis test was used to compare LS values of CP scores, and the receiver-operator characteristic (ROC) curve was used to analyze liver reserve function assessment accuracy. LS in the ICG-R15 10%-20% group was significantly higher than in the ICG-R15 < 10% group; and the difference was statistically significant (2.19 ± 0.27 vs 1.59 ± 0.32, P < 0.01). LS in the ICG-R15 > 20% group was significantly higher than in the ICG-R15 < 10% group; and the difference was statistically significant (2.92 ± 0.29 vs 1.59 ± 0.32, P < 0.01). The LS value in patients with CP class A was lower than in patients with CP class B (1.57 ± 0.34 vs 1.86 ± 0.27, P < 0.05), while the LS value in patients with CP class B was lower than in patients with CP class C (1.86 ± 0.27 vs 2.47 ± 0.33, P < 0.01). LS was positively correlated with ICG-R15 (r = 0.617, P < 0.01) and CP score (r = 0.772, P < 0.01). Meanwhile, LS was negatively correlated with ICG-K (r = -0.673, P < 0.01). AST, ALT and T-Bil were positively correlated with LS, while ALB was negatively correlated with LS (P < 0.05). The ROC curve revealed that the when the LS value was 2.34 m/s, the Youden index was at its highest point, sensitivity was 69.2% and specificity was 92.1%. For patients with liver tumors, ARFI imaging is a useful tool for assessing liver reserve function.

Giant secreting adrenal myelolipoma in a man: a case report

IntroductionAdrenal myelolipoma is a rare, benign neoplasm that is usually asymptomatic, unilateral and nonsecreting. It develops within the adrenal gland and is composed of mature adipose tissue with elements of the hematopoietic series. We describe the case of what is, to the best of our knowledge, one of the largest secreting adrenal myelolipomas reported in the literature.Case presentationA 52-year-old Caucasian man of medium build who had had moderate hypertension for three years presented to our hospital. He had no other significant symptoms. His hypertension was pharmacologically treated. He came to our hospital to undergo abdominal ultrasonography during a clinical checkup. The ultrasound scan showed the presence of a voluminous hyperechoic mass interposed between the spleen and the left kidney. It was reported as a myelolipoma of the left kidney on the basis of its structural characteristics and position. Computed tomography confirmed our diagnosis. All preoperative biochemical tests were normal, with the exception of high serum cortisol, which was being overproduced by the lesion and was probably responsible for the patient's hypertension. He underwent successful surgery, and his postoperative course was uneventful. The pathologic examination of the lesion confirmed the diagnosis of adrenal myelolipoma. The patient's blood pressure returned to within the normal range.ConclusionsThe "incidental" discovery of an adrenal mass requires careful diagnostic study to plan adequate therapeutic management. Both of the primary investigations at our disposal, ultrasound and blood tests (adrenal hormones), helped in rendering the diagnosis and allowed us to move toward the most appropriate treatment, taking into account the size of the tumor and its probable hormonal production.

Role of Routine Preoperative Biochemistry in Anaesthesia

Objectives: To assess the value of routine preopera-tive biochemical tests and their effects on anaesthetic management. Design: A cross sectional study. Place and Duration of Study: Shalamar Hospital, Lahore. From August 1 st 2009 to November 30 th 2009. Methodology: We studied consecutive 500 ASA I and ASA II patients, 40 years of age and above, sche-duled for elective surgery. Patients with any disease or factor that can lead to metabolic disturbance were ex-cluded from the study. Results: Patients were divided into 4 age groups, (Group A (40 - 49 years), Group B (50 - 59 years), Group C (60 - 69 years) and Group D (more than 70 years). Total abnormalities detected were 8 (1.6%). Abnormal blood sugar was found in 5 cases, 1.1% of all the tested patients, which belonged to age group A (1.7% of the group population). Abnormal blood urea was found in 2 cases which is 0.4% of the tested popu-lation and all of these belonged to age group D (2.8% of the age group population). Abnormal creatinine was found in one of the two cases of abnormal blood urea in the age group D, which is 0.2% of the tested popula-tion (1.4% of the group population). Serum electrolyte abnormalities were not found in any patient. The anae-sthetic management was changed in 5 cases with abno-rmal blood sugar and was not influenced in patients with abnormal blood urea and serum creatinine. Conclusion and Recommendation: Routine pre-operative serum electrolytes in patients, aged 40 - 70 years with no history of cardiac disease, renal disease and diabetes are not recommended. We recommend routine preoperative estimation of blood sugar in the all patients above the age of 40 years and renal func-tion tests in patients above the age of' 70 years. Key Words: Routine preoperative blood sugar, Urea, Creatinine, peri and postoperative, anaesthetic mana-gement.

Cholescintigraphy and Biochemical Tests in Cholecystitis - An Evaluation with Discriminant Analysis

The biochemical values of 76 patients with suspected cholecystitis were subjected to discriminant analysis. The final diagnoses, i.e. acute cholecystitis, chronic cholecystitis and non-biliary disease, were used as the grouping variable. Cholescintigraphy identified patients with acute cholecystitis. Routine preoperative biochemical tests were found to be of limited value. Only alkaline phosphatase was of help in predicting common-duct stones, especially in patients with acute cholecystitis. The conclusion is that many biochemical tests presently in common use could as well be dispensed with.