Preoperative Clinical Data Research Articles

Curative effect analysis of two surgical methods for removal of pituitary adenoma via endonasal transsphenoidal approach

Objective: To compare the efficacy of endoscopic endonasal transsphenoidal surgery and microsurgery for pituitary adenomas. Methods: One hundred and ten patients with pituitary adenoma who were treated by single nostril transsphenoidal surgery in the department of neurosurgery of the First Affiliated Hospital of Bengbu Medical College from June 2014 to December 2016 were enrolled.These cases were randomly divided into endoscopic group 53 cases (including 36 cases of functional pituitary adenoma and 17 cases of non-functional pituitary adenoma) and microscope group 57 cases (including 34 cases of pituitary adenoma and 23 cases of non-functional pituitary adenomas), with no significant difference in preoperative clinical data about gender, age, tumor size and endocrine function (P>0.05). The total tumor resection rate, postoperative complication rate and the rate of functional tumor hormone levels were compared between the two groups. Results: The total resection rate of tumor in patients with endoscope and microscope group were 75.5% (40/53) and 70.2% (40/57) without statistically significant difference (P>0.05). The total resection rate and hormone level decline effective rate of functional pituitary adenomas in neuroendoscope group (91.7%, 33/36; 83.3%, 30/36) were higher than those in microscope group (70.6%, 24/34; 61.8%, 21/34) with statistically significant difference (P<0.05). Another side, there was no statistically significant difference in total resection of non-functional pituitary adenomas between endoscope group (41.2%, 7/17) and microscope group (69.6%, 16/23) (P>0.05). The total incidence of postoperative complications in endoscopic group (9.4%, 5/53) was lower than that in the microscope group (24.6%, 14/57), with statistically significant difference (P<0.05), in which the rate of postoperative complications of functional pituitary adenomas and nonfunctional pituitary adenoma in endoscopy group (8.3%, 3/36; 11.8%, 2/17) and in microscope (20.6%, 7/34; 30.4%, 7/23) had no statistical significance (P>0.05). Conclusion: Pituitary adenoma resection rate in two ways had no obvious difference, but the advantages of endoscopic surgery for functional pituitary adenomas were obvious.The incidence of postoperative complications of endoscopic surgery was lower than that of microscopic surgery, but there was no difference between functional and non-functional tumors.

Efficacy of single-stage and two-stage Fowler–Stephens laparoscopic orchidopexy in the treatment of intraabdominal high testis

To compare the curative effect of single-stage and two-stage Fowler-Stephens (F-S) laparoscopic orchidopexy for intraabdominal high testis and explore the appropriate surgical approach. We performed a prospective analysis of the clinical data of 28 patients who underwent F-S laparoscopic orchidopexy for intraabdominal high testis in our department from May 2012 to April 2015, including 15 cases of the single-stage F-S operation and 13 cases of the two-stage F-S operation. By comparing the two groups preoperative and postoperative (6 months) clinical data of testicular position, testicular volume, and sex hormone levels [testosterone (T), follicle stimulating hormone (FSH), and estradiol (E2)], we analyzed the difference in efficacy between the two procedures. Twenty-eight patients completed laparoscopic surgery, no case was converted, and no testis was excised. All patients were followed up for 9-25 months after the operation, with an average follow-up of 16.2 months. The postoperative testicular volume of the single-stage and two-stage F-S groups was not significantly reduced (p>0.05). In both groups, the postoperative T levels were significantly increased compared to the preoperative levels (p<0.05), while the FSH and E2 levels were significantly decreased (p<0.05). The differences in testicular volume and T, FSH, and E2 levels between the two surgical procedures were not significant (p>0.05). In the single-stage F-S group, the testes were located in the scrotum in 13 cases and retracted to the lower groin in two cases. In the two-stage F-S group, the testes were located in the scrotum in 12 cases and retracted to the lower groin in one case. The difference in postoperative testicular position between the two groups was not significant (p>0.05). In the case of testis with good collateral circulation, single-stage F-S laparoscopic orchidopexy had the same safety and efficacy as the two-stage F-S procedure. Surgical options should be based on comprehensive consideration of intraoperative testicular location, testicular ischemia test, and collateral circumstances surrounding the testes. Under the appropriate conditions, we propose single-stage F-S laparoscopic orchidopexy be preferred. It may be appropriate to avoid unnecessary application of the two-stage procedure that has a higher cost and causes more pain for patients.

Resultados del recambio valvular pulmonar según el tipo de prótesis implantada

Introduction and objectivesPulmonary valve replacement has become the most frequent intervention in adults with congenital heart disease. There is some controversy with respect to the time to intervene and the optimal prosthesis to implant. The objective of this study is to present a review of the performance of three different pulmonary bio-prostheses in our centre between 2003 and 2015. MethodsThe population was divided into three groups according to the prosthesis implanted: Group 1-Medtronic Freestyle (n=14), Group 2-Sorin Soprano (n=24), and Group 3-Carpentier Edwards (n=15). Pre-operative, post-operative, and follow-up clinical and echocardiographic data were recorded. ResultsPulmonary valve replacement resulted in a better post-operative New York Heart Association and left ventricular function improvement in our population. No significant pre-operative differences were seen between groups.In first echocardiogram after surgery, a greater valve gradient was found in Medtronic Freestyle group (P=.053), although it remained stable during follow up. The Sorin Soprano group was associated with a higher valve dysfunction rate (P=.004). There were 20 valve dysfunctions in our series, with 5 of them requiring a valve replacement. There were no early deaths, and only 4 patients died during follow up, with 1 as a cardiac cause. The mean follow-up time was 49.98 months (SD=42.79). ConclusionsPulmonary valve replacement had a low perioperative mortality rate in our series. When comparing between different prosthesis, a higher initial gradient was found in the Medtronic Freestyle group. The Sorin Soprano valve was associated with a higher valve dysfunction rate. However, a longer follow-up is needed to evaluate the performance of the Carpentier Edwards valve.

MP64-20 PATHOLOGICAL UPGRADING AND UPSTAGING AT RADICAL PROSTATECTOMY IN JAMAICAN MEN WITH LOW RISK PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy V1 Apr 2017MP64-20 PATHOLOGICAL UPGRADING AND UPSTAGING AT RADICAL PROSTATECTOMY IN JAMAICAN MEN WITH LOW RISK PROSTATE CANCER Belinda Morrison, Gareth Reid, Richard Mayhew, William Aiken, and Barrie Hanchard Belinda MorrisonBelinda Morrison More articles by this author , Gareth ReidGareth Reid More articles by this author , Richard MayhewRichard Mayhew More articles by this author , William AikenWilliam Aiken More articles by this author , and Barrie HanchardBarrie Hanchard More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1993AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Several studies suggest race-based health disparities in men with low-risk prostate cancer (PCa), with African-American males having poorer oncological outcomes. We sought to determine the predictors of pathological upgrading and upstaging in a cohort of black Jamaican males with low-risk PCa who underwent radical prostatectomy (RP) between 2000 and 2015. METHODS We studied 141 men who met National Comprehensive Cancer Network criteria for low-risk PCa and underwent RP at the University Hospital of the West Indies, Kingston, Jamaica. All men had a minimum of a 12 core trans-rectal ultrasound-guided biopsy. Pre-operative clinical and final pathological data were obtained. Data were summarized as means and standard deviations or percentages as appropriate. Bivariate analyses such as independent samples t tests and chi square tables were conducted and logistic regression models were estimated to predict upgrading (> Gleason 6) and upstaging (≥ pT3). RESULTS Mean age was 59.5 ± 7.8 years with mean PSA of 6.6 ± 2 ng/ml. A total of 48.3% of men were upgraded and 30.8% were upstaged. Bivariate analyses indicated that PSA levels (p=0.008) and percentage of cancer found on biopsy (p=0.002) were associated with upgrading. Clinical T stage (p=0.020), number of positive cores found (p=0.024) and the percentage of cancer found on biopsy (p=0.004) were significantly associated with upstaging. The odds of upgrading increased with increased PSA levels (OR = 1.40; p= 0.021) or increased percentages of cancer found (OR = 8.27; p = 0.002). The odds of upstaging increased with increased percentages of cancer found (OR = 3.62; p = 0.039). CONCLUSIONS Jamaican males with low-risk PCa have high rates of poor pathological outcomes. Percentage cancer found on biopsy is significantly associated with upgrading and upstaging. These findings should be taken into consideration when discussing treatment options for these patients. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e852 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Belinda Morrison More articles by this author Gareth Reid More articles by this author Richard Mayhew More articles by this author William Aiken More articles by this author Barrie Hanchard More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prognostic Predictors of Visual Outcome in Open Globe Injury: Emphasis on Facial CT Findings.

The present prognostic models for open globe injuries have a limited ability to predict visual outcome before a comprehensive ophthalmologic examination or operation because they depend on the data derived from the ophthalmologic examination and intraoperative findings. The purpose of our study was to determine the specific CT and preoperative clinical data that can predict the prognosis of open globe injury. We analyzed the relationship of 29 variables derived from clinical and CT data from 97 globe injuries with visual acuity at 1 month. A prediction model was derived from 49 globe injuries by regression analysis, followed by receiver operating characteristic curve analysis of the best CT predictor. Four variables with significance on a regression model were the following: posterior segment hemorrhage (β = -0.93, P < .0001), presenting visual acuity (β = 0.28, P = .042), orbital emphysema (β = 0.46, P = .0018), and complex facial fracture (β = -0.43, P = .009). Receiver operating characteristic analysis of the posterior segment hemorrhage predicted profound vision loss (light perception or no light perception) with an area under the curve of 0.97. The receiver operating characteristic table indicated that grade III posterior segment hemorrhage has a strong positive predictive value of 100% for profound vision loss. On the other hand, the absence of posterior segment hemorrhage has a strong positive predictive value of 93% for mild-to-severe vision loss (visual acuity better than light perception). Radiologists, with the help of CT and preoperative clinical data, can predict visual acuity after open globe injury.

Management of Bladder Cancer After Renal Transplantation

ObjectivesIn renal transplant recipients, the risk of developing bladder cancer and rate of diagnosis of advanced staged bladder cancer are generally higher than the general population. Also, it is more challenging to treat renal transplant recipients than the regular patient population. We aimed to evaluate the efficacy and safety of radical cystectomy (RC) and urinary diversion with ileal conduit in renal transplant recipients. MethodsWe identified 2 patients with prior history of renal transplantation who underwent RC and ileal conduit urinary diversion for bladder cancer. Preoperative clinical and demographic data were presented and outcomes were assessed. ResultsThe RC and ileal conduit urinary diversion were performed in the first patient 56 months after renal transplantation and in the second patient 64 months after renal transplantation. Clinical staging was high-grade T2 transitional cell cancer of the bladder for patient 1 and T2 with pure squamous cell cancer of the bladder for patient 2. No perioperative or postoperative complication and no graft dysfunction occurred in either patient. ConclusionOur experience demonstrated that RC with ileal conduit reconstruction in renal transplant recipients is safe and feasible.

Incidence of Facial Nerve Canal Dehiscence in Primary and Revision Cholesteatoma Surgery.

The aim of this retrospective study was to determine the incidence of facial canal dehiscence (FCD) in primary and revision cholesteatoma surgery in a tertiary referral center. Moreover, our second goal was to identify association between FCD and other intra-operative pathological findings in a group of patients with cholesteatoma surgery. Inclusion criteria were primary and revision canal wall up and canal wall down tympanomastoidectomy in patients who suffers from chronic otitis media (COM) with cholesteatoma. An exclusion criterion was charts with in adequate documentation. In addition tympanoplasty cases were excluded due to evaluate both tympanic and mastoid segments of facial nerve canal. Preoperative clinical data and intra-operative findings were documented in a formatted questionnaire. We found the incidence of FCD in COM surgery was 18%. There was no difference between the primary and revision surgeries regarding its incidence. In addition, there was association between some preoperative or intra-operative findings of COM, such as middle fossa dural dehiscence, external auditory canal polyp, facial nerve paralysis, labyrinthine fistula, and FCD. In conclusions we found that there was no difference between primary and revision surgeries regarding the incidence of FCD. Surgeons should consider effective measures to prevent intra-operative facial nerve trauma in COM surgeries.

Relationship between High Red Cell Distribution Width and Systemic Inflammatory Response Syndrome after Extracorporeal Circulation.

ObjectiveCardiac surgical operations involving extracorporeal circulation may develop severe inflammatory response. This severe inflammatory response syndrome (SIRS) is usually associated with poor outcome with no predictive marker. Red cell distribution width (RDW) is a routine hematological marker with a role in inflammation. We aim to determine the relationship between RDW and SIRS through our study.MethodsA total of 1250 patients who underwent cardiac surgery with extracorporeal circulation were retrospectively analyzed out of which 26 fell into the SIRS criteria and 26 consecutive control patients were taken. RDW, preoperative clinical data, operative time and postoperative data were compared between SIRS and control groups.ResultsThe demographic profile of the patients was similar. RDW was significantly higher in the SIRS versus control group (15.5±2.0 vs. 13.03±1.90), respectively with P value <0.0001. There was significant mortality in the SIRS group, 20 (76.92%) as compared to 2 (7.6%) in control group with a P value of <0.005. Multiple logistic regression analysis revealed that there was significant association with high RDW and development of SIRS after extracorporeal circulation (OR for RDW levels exceeding 13.5%; 95% CI 1.0-1.2; P<0.05).ConclusionIncreased RDW was significantly associated with increased risk of SIRS after extracorporeal circulation. Thus, RDW can act as a useful tool to predict SIRS in patients undergoing cardiac surgery with extracorporeal circulation. Hence, more aggressive measures can be taken in patients with high RDW to prevent postoperative morbidity and mortality.

Prognostic value of inflammation-based markers in patients with recurrent malignant obstructive jaundice treated by reimplantation of biliary metal stents: A retrospective observational study.

We aimed to assess the therapeutic effect of reimplantation of biliary metal stents by percutaneous transhepatic cholangial drainage (PTCD) in patients with recurrent malignant obstructive jaundice (MOJ). Furthermore, we explored the prognostic value of inflammation-based markers in these patients.We reviewed 33 cases of recurrent MOJ after implantation of biliary metal stents by PTCD, all of which underwent reimplantation of stents under digital subtraction angiography guidance. Levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin were compared between before and after reimplantation (1 week, 1 month, and 3 months postoperatively). Preoperative clinical data were collected to calculate the inflammation-based markers, including systemic immune-inflammation index (SII, neutrophil × platelets/ lymphocyte), platelets-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and monocyte-to-lymphocyte ratio (MLR). The primary outcome was overall survival (OS), which was estimated by the Kaplan–Meier method and Cox regression analysis.The levels of ALT, AST, total bilirubin, and direct bilirubin significantly reduced after the reimplantation operation. During a median follow-up time of 10 months, 18 (54.5%) patients died. Gender, albumin, SII, PLR, NLR, and MLR were found to be associated with OS by the log-rank test and univariate analysis. Multivariate Cox analysis identified elevated levels of SII and PLR as significant factors for predicting poor OS.Reimplantation is clinically feasible in patients with recurrent MOJ after implantation of biliary metal stents. SII and PLR are independent, useful inflammation-based prognostic models for predicting outcomes in these patients.

Postsurgical outcome in patients with auditory auras and drug-resistant epilepsy.

We assessed whether patients with auditory auras have similar outcomes after epilepsy surgery as patients without auditory auras, and hypothesized that patients with non-dominant hemisphere foci might fare better after temporal lobe surgery than patients with dominant resections. In this retrospective study, outcome after temporal resection was assessed for patients with drug-resistant epilepsy. Preoperative demographic data, clinical data, and surgical outcome were prospectively registered in a database from 1986 through 2016. Seizure outcome was classified as either seizure-free or relapsed. Data were available in 1186 patients. Forty five patients (3.8%) reported auditory auras; 42 patients (93%) had temporal lobe epilepsy (TLE), and three patients (7%) had extratemporal epilepsy. Since most patients with auditory auras had TLE and in order to have comparable groups, we selected 41 patients with auditory auras and compared them with patients without auditory auras who had temporal lobe resections (767 patients). There were no significant demographic or clinical differences between TLE patients with auditory auras and those without. Patients who had auditory auras were more likely to relapse after temporal lobe surgery than those without (p=0.03). Among patients who had auditory auras and temporal lobe surgery, side of surgery was not related to postoperative outcome (p=0.3). Auditory auras are rare among patients with drug-resistant TLE. The presence of an auditory aura in a patient with drug-resistant TLE carries a worse prognosis for a postoperative seizure free outcome and this is not related to the side of surgery.

Soft tissues and bone healing response in impacted third molar osteotomies

Objective: To determine differences between bone healing and soft tissues in the lower jaw of patients subjected to impacted third molar extraction after using a high and low speed rotary devices. Material and methods: Crossed clinical assay-type intervention study. Under local anesthsesia, forty tooth extractions were performed (right and left) from 20 healthy patients. Two groups were thus formed: in group 1 high speed hand-piece was used, in group 2, low speed hand-piece was employed. Index cards were used to record time devoted to each patient as well as preoperative and postoperative clinical data related to inflammation, pain, opening limitations, bone healing and periodontal changes in the adjacent teeth. Results: When comparing high and low speed hand-pieces, statistically significant differences were found between pain, surgical time and probing depth; it was observed that low speed hand-piece generated lesser aggression to soft tissues. Conclusions: Accurate use of low speed hand-pieces allows a decrease of surgical time thus providing the patients with more suitable postoperative evolution.

Characteristics and Clinical Relevance of the Osseous Spur in Patients with Congenital Scoliosis and Split Spinal Cord Malformation.

The natural history of split spinal cord malformation (SCM) is still unclear. Knowledge of the characteristics of the osseous spur and its relationship with the spinal deformity may allow early identification of patients with a higher risk of a neurological deficit and enhance surgical decision-making. Eighty-five consecutive patients with congenital scoliosis and type-I SCM who had undergone surgical treatment at our hospital from May 2000 to December 2013 were identified retrospectively. There were 22 male and 63 female patients with an average age of 13.9 years at the time of surgery. Preoperative clinical and radiographic data were collected to investigate the characteristics of the scoliosis and the osseous spur. Two groups were identified on the basis of whether the patients had intact neurological function (Group A) or a neurological deficit (Group B). There were 52 patients (61%) in Group A (intact neurological function) and 33 patients (39%) in Group B (neurological deficit). There were no significant differences in the demographic distribution, curve magnitude, or length and thickness of the osseous spur between the 2 groups. In Group A, the location of the osseous spur relative to the apex of the major curve was proximal in 13 patients (25%), distal in 28 (54%), and central in 11 (21%). In Group B, the osseous spur was proximal in 7 (21%), distal in 8 (24%), and central in 18 (55%). The 2 groups differed significantly with respect to the location of the osseous spur (chi square = 10.898, p = 0.004). Group-B patients had a higher proportion of patients with kyphotic deformity (42%) than Group A (10%). The ratio of the diameters of the hemicords (concave side divided by convex side) differed significantly between the 2 groups (0.98 for Group A versus 0.89 for Group B, p = 0.030). The neurological status in patients with congenital scoliosis and type-I SCM appears to be closely related to the location of the osseous spur relative to the congenital scoliosis. An osseous spur at the apex of the scoliosis may be related to a higher risk of developing a neurological deficit, especially in patients with kyphotic deformity. Asymmetric splitting of the spinal cord may contribute to neurological deficits. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Staged or Combined Approach for Carotid Endarterectomy in Patients Undergoing Coronary Artery Bypass Grafting: A 5-Year-Long Experience.

Optimal surgical approach for patients with hemodynamically significant carotid and coronary disease remains controversial. We analyzed our 5-year experience and compared early and long-term outcome following staged and combined carotid and coronary artery bypass. 312 consecutive patients undergoing carotid endarterectomy and coronary artery bypass between 2008 and 2013 were prospectively enrolled in the study. Patients were scheduled for a staged (carotid endarterectomy followed by coronary artery bypass within 1 week) procedure (Group S) unless they were unstable in terms of cardiac status (were deemed to a combined procedure; Group C). All patient data including demographics, risk factors, immediate perioperative events, 30-day, and long-term outcome were prospectively recorded and then analyzed. Groups S and C were compared for pre- and perioperative data as well as immediate, 30-day, and long-term survival. A P value less than .05 was considered significant. Survival analysis was made using Kaplan-Meier method and log-rank test. Group S included 204 patients and Group C included 108 patients. Preoperative demographics and clinical data were similar in the two groups except that preoperative cerebrovascular events were more common in Group C (31.7% versus 22.22%, P = .036) and bilateral carotid disease was more common in Group S. The EuroSCORE was higher in Group C (2.91 versus 2.65, P = .013). Carotid surgery techniques were similar; intraluminal shunting was more frequent in group C than group S (33.33% versus 9.88%, P = .001). Additional cardiac procedures in addition to coronary surgery was predominant in Group C. 30-day neurological adverse event rates, ICU, and hospital stay were significantly higher in Group C. The 30-day mortality was also sigficantly higher in Group C (1.96% versus 4.62%, P = .001). Staged and combined surgical approaches yield comparable outcomes. A staged approach may provide a more favorable neurological outcome with significantly reduced need for intraluminal shunting. Long-term outcome is, however, similar.

Stone Attenuation Values Measured by Average Hounsfield Units and Stone Volume as Predictors of Total Laser Energy Required During Ureteroscopic Lithotripsy Using Holmium:Yttrium-Aluminum-Garnet Lasers

To evaluate the predictors of the total laser energy (TLE) required during ureteroscopic lithotripsy (URS) using the holmium:yttrium-aluminum-garnet (Ho:YAG) laser for a single ureteral stone. We retrospectively analyzed the data of 93 URS procedures performed for a single ureteral stone in our institution from November 2011 to September 2015. We evaluated the association between TLE and preoperative clinical data, such as age, sex, body mass index, and noncontrast computed tomographic findings, including stone laterality, location, maximum diameter, volume, stone attenuation values measured using average Hounsfield units (HUs), and presence of secondary signs (severe hydronephrosis, tissue rim sign, and perinephric stranding). The mean maximum stone diameter, volume, and average HUs were 9.2 ± 3.8 mm, 283.2 ± 341.4 mm3, and 863 ± 297, respectively. The mean TLE and operative time were 2.93 ± 3.27 kJ and 59.1 ± 28.1 minutes, respectively. Maximum stone diameter, volume, average HUs, severe hydronephrosis, and tissue rim sign were significantly correlated with TLE (Spearman's rho analysis). Stepwise multiple linear regression analysis defining stone volume, average HUs, severe hydronephrosis, and tissue rim sign as explanatory variables showed that stone volume and average HUs were significant predictors of TLE (standardized coefficients of 0.565 and 0.320, respectively; adjusted R2 = 0.55, F = 54.7, P <.001). Stone attenuation values measured by average HUs and stone volume were strong predictors of TLE during URS using Ho:YAG laser procedures.

Minimally invasive versus standard laparotomic interval debulking surgery in ovarian neoplasm: A single-institution retrospective case-control study

ObjectiveTo further investigate the role of MIS comparing patients submitted to MI-IDS with a balanced population treated by standard laparotomy. MethodsThe investigational arm (Cases) includes 30 AEOC patients treated with MI-IDS. The Control arm included a consecutive series of 65 AEOC patients submitted to laparotomic IDS. Inclusion criteria were: age>18years, histologically proven EOC, clinical complete/partial response after NACT, and ECOG PS <2. Preoperative clinical data, perioperative and oncological outcomes were analyzed. General Well-Being Schedule (GWBS) was administered to evaluate quality of life before and after surgery. ResultsBoth groups were well-balanced. A higher percentage of women among Cases received bevacizumab-containing NACT compared with Controls.No statistical differences were registered in terms of surgical procedures and residual tumor.A significantly longer median OT in Cases was counterbalanced by more favorable EBL and median length of stay and TTC. No statistically significant differences were registered in terms of postoperative complications.Cases showed a 6months longer PFS compared to Controls. However, in multivariate analysis only the administration of Bevacizumab and a shorter TTC were independently associated with a longer PFS.Regarding QoL, no statistically significant differences were registered in Cases between pre- and postoperative GWBS score. Differently from Controls where this difference was statistically significant and a more intense distress were recorded. ConclusionsMinimally invasive approach could represent an advantageous alternative surgical way to perform interval debulking surgery in this specific subset of patients, with no impact on PFS. Based on these findings a randomized clinical trial is now under evaluation in our Institution.

Comparison of Laparoscopic Approaches for Dismembered Pyeloplasty in Children With Ureteropelvic Junction Obstruction: Critical Analysis of 11-Year Experiences in a Single Surgeon

The choice of different laparoscopic approaches of laparoscopic pyeloplasty (LP) in children remains controversial. We present a comparison of different approaches of LP in children and a critical analysis of 11-year experiences in a single surgeon. There were 1750 patients (1889 sides) who underwent LP between 2003 and 2014 reviewed. The diagnosis and outcomes of ureteropelvic junction obstruction (UPJO) were reviewed based on clinical and imaging data. Retroperitoneal laparoscopic pyeloplasty (RPLP) were performed in 451 cases (RPLP group), conventional transperitoneal laparoscopic pyeloplasty (CTLP) were performed in 311 cases (CTLP group), transumbilical single-site laparoscopic pyeloplasty (TSLP) were performed in 322 cases (TSLP group), and transumbilical multiport laparoscopic pyeloplasty (TMLP) were performed in 805 cases (TMLP group). We assessed preoperative clinical data and outcomes, and analyzed the transition experience. Data are expressed as medians for continuous variables. The start of oral feeding, hospital stay, and the operative time of RPLP group were 1.10 ± 0.10 days, 5.22 ± 1.32 days, and 138.2 ± 20.1 minutes, respectively. Compared with the other 3 groups, the start of oral feeding was the soonest, hospital stay was the shortest, and the operative time was the longest in the RPLP group (P < .01 or .05). The cosmetic result of the TMLP group was 7.07 ± 1.20 scores, and there are significant differences in cosmetic results between the TMLP group and the other 3 groups (P < .05). Although the 4 laparoscopic approaches for LP in children with UPJO are safe and efficient procedures with equivalent success rates, we recommend RPLP or TMLP as a treatment option for children with UPJO.

Acute Appendicitis During Pregnancy: Different from the Nonpregnant State?

Acute appendicitis is the most common nonobstetric indication for surgical intervention during pregnancy. However, the current literature is scarce and composed of relatively small case series. We aimed to compare the presentation, management, and surgical outcomes of presumed acute appendicitis between a contemporary cohort of pregnant women and nonpregnant women of reproductive age. The study group included 92 pregnant patients who underwent appendectomy for presumed acute appendicitis at a single tertiary medical center in 2000-2014. Preoperative, operative, and postoperative clinical data were derived from medical records and compared to data for 494 nonpregnant patients of reproductive age who underwent appendectomy in 2004-2007 at the same institution. Median age was 28years (range 25-33) in the study group and 26years (range 20-34) in the control group (P=0.1). There were no between-group differences in mean white blood cell count, patient interval, hospital interval, or operative time. Preoperative abdominal ultrasound was used in a significantly higher proportion of patients in the pregnant group than in the nonpregnant group (73 and 27%, respectively, P<0.001) and computed tomography, in a significantly lower proportion of patients (1 vs. 16%, respectively, P<0.001) . The two groups had similar rates of negative appendectomy (23 and 22%, P=0.9), complicated appendicitis (12 and 11%, P=0.9), and overall postoperative complications (15 and 12%, P=0.3). The clinical presentation and outcome of presumed acute appendicitis are similar in pregnant women and nonpregnant women of reproductive age. Therefore, similar perioperative management algorithms may be applied in both patient populations.

Transforaminal Endoscopic Surgery for Adjacent Segment Disease After Lumbar Fusion

The natural history of degenerative disease after instrumented lumbar fusion can result in symptomatic radiculopathy at the adjacent segment. Here we describe our experience with transforaminal endoscopic decompression for the treatment of adjacent segment radiculopathy. A technique for the transforaminal endoscopic treatment of lumbar radiculopathy adjacent to instrumented lumbar fusions is presented. Prospectively, we followed a series of 9 consecutive patients operated on with lumbar radiculopathy above (5) or below (4) their instrumented fusion. Preoperative and postoperative clinical data with 2-year follow-up are presented. A consecutive series of 9 patients who underwent transforaminal endoscopic treatment for lumbar radiculopathy adjacent to an instrumented spinal fusion between 2012 and 2014 is presented. Three patients required revision to fusion at 2, 13, and 19 months postoperatively. The mean visual analogue scale score for radicular pain improved from an average pain score before surgery of 8.4 to 1.3 1 year after surgery and the mean visual analogue scale for back pain improved from an average pain score before surgery of 8.0 to 4.7 1 year after surgery (excluding the 1 patient with 2month postoperative failure). Transforaminal endoscopic surgical access to adjacent level disease pathology may be a unique approach to the treatment of adjacent segment disease because it allows for neural decompression of disc and foraminal pathology without requiring significant destabilizing bone removal. However, the 2-year failure rate presented here is 33%, which indicates that the benefit of this technique may ultimately be temporary.

Bariatric Surgery for Patients With Early-Onset vs Late-Onset Type 2 Diabetes

The prevalence of early-onset type 2 diabetes mellitus (T2DM), which responds poorly to medical treatment, is increasing. Bariatric surgery has been well recognized for its effectiveness in the remission of T2DM, but its effectiveness and durability in the remission of early-onset T2DM has not yet been explored. To compare the short- and long-term outcomes of bariatric surgery with a specific focus on the rate of remission of T2DM in patients with early-onset (age <40 years) and late-onset (age ≥40 years) T2DM. In this cohort study, 558 Taiwanese patients (339 with early-onset T2DM and 219 with late-onset T2DM) with a body mass index (calculated as weight in kilograms divided by height in meters squared) above 25 underwent bariatric surgery to ameliorate T2DM between January 1, 2007, and December 31, 2013. Patients were followed up for at least 1 year. Preoperative, perioperative, and postoperative clinical and laboratory data were prospectively collected and compared between the 2 groups. Rate of remission of T2DM (hemoglobin A1C <6.0% without antiglycemic medication) was the primary outcome measure. Of the 558 patients (345 women) in the study, mean (SD) ages were 33.5 (7.5) for those with early-onset T2DM and 50.6 (6.5) with late onset T2DM. Those with early-onset T2DM had higher mean (SD) preoperative BMI and hemoglobin A1C values (39.4 [8.5] and 8.7% [3.8%] of total hemoglobin [to convert hemoglobin to a proportion of total hemoglobin, multiply by 0.01], respectively) than did patients with late-onset T2DM (36.7 [7.5] and 8.2% [1.6%], respectively). Distribution of surgical procedures and major complications were similar between the 2 groups. At 1 year, patients with early-onset T2DM achieved greater weight loss than those with late-onset T2DM, although the difference was not statistically significant. A higher rate of complete remission of T2DM was observed in patients with early-onset T2DM than in those with late-onset disease (193 [56.9%] vs 110 [50.2%]; P = .02). At 5 years, patients with early-onset T2DM still maintained a higher rate of weight loss (mean [SD], 30.4% [11.8%] vs 21.6% [11.7%]; P = .002) and higher rate of remission (47 of 72 [65.3%] vs 26 of 48 [54.2%]; P = .04) than did those with late-onset disease. Age at bariatric surgery, duration of T2DM, and preoperative C-peptide level were independent predictors of remission. The remission rate was directly related to extent of weight loss. Multivariate analysis confirmed the higher rate of remission in the group with early-onset T2DM. This article describes the largest long-term study examining bariatric surgery for patients with early-onset T2DM. Bariatric surgery may achieve better and more long-lasting glycemic control in select patients with early-onset T2DM than in those with late-onset T2DM.

Prognostic and predictive values of diffusion and perfusion MRI in paediatric intracranial ependymomas in a large national study.

To assess the relative cerebral blood volume (rCBV) and apparent diffusion coefficient (ADC) derived, respectively, from perfusion and diffusion pre-operative MRI of intracranial ependymomas and their predictive and prognostic values. Pre-operative MRI and clinical data for intracranial ependymomas diagnosed between January 2000 and December 2013 were retrospectively retrieved from a web-based national database. MRI data included diffusion (62 patients) and perfusion (20 patients) MRI. Patient age, histopathological diagnosis, tumour location, ADC, relative ADC (rADC) and rCBV were considered as potential factors in a survival analysis. Survival rates were estimated using the Kaplan-Meier method. Univariate analyses were performed using the log-rank test to compare groups. We also performed a multivariate analysis, applying the Cox proportional hazards model. ADC and rADC values within hypointense regions differed significantly between grades II and III (p = 0.01). The 75th percentile of ADC within hypointense regions and the 25th percentile of rCBV within non-enhancing lesions were prognostic of disease-free survival (p = 0.004, p = 0.05). A significant correlation was found between the 75th percentile of rCBV and the 25th percentile of rADC (p = 0.01) in enhancing regions of grade-III tumours. Pre-operative rADC and rCBV could be used as prognostic factors for clinical outcome and to predict histological grade in paediatric ependymomas. Prognostic value of diffusion and perfusion MRI in paediatric ependymoma was found and may play a role in the prognostic classification of patients in order to design more tailored treatment strategies.