Preoperative Laboratory Investigations Research Articles

Effect of endoscopic sinus surgery on eustachian tube function in adult patients with chronic rhinosinusitis

BackgroundChronic rhinosinusitis (CRS) is a frequent chronic heterogeneous inflammatory disease of the upper airways and paranasal sinuses persistent for ≥ 12 weeks causing considerable healthcare expenses and reduction of patients’ quality of life due to severe tiredness and disappointment as well as diminished cognitive function. CRS is commonly associated with eustachian tube (ET) dysfunction.Aim of the studyTo evaluate the effect of endoscopic sinus surgery on ET function in the form of (tympanogram, Valsalva maneuver, and total ET dysfunction questionnaire score), in adult patients with CRS.MethodThis non-randomized clinical trial study was conducted at the Otorhinolaryngology department, the Faculty of Medicine, Cairo University, on 40 patients > 18 years old, suffering from CRS with or without sinonasal polyposis who are indicated for endoscopic sinus surgery (ESS) and were recruited from Otorhinolaryngology department’s outpatient clinic in the period from November 2022 to June 2023. All selected patients were subjected to a full history taken, a full general examination, and a local otorhinolaryngology examination. Routine preoperative laboratory investigation including complete blood count (CBC), liver and kidney function tests, and coagulation profile. An electrocardiogram (ECG) examination was done routinely for all patients above 40 years old. Radiological examination included the following: preoperative CT nose and paranasal sinus, axial and coronal soft tissue cuts, and bone windows. Assessment of ET function was done using the ET dysfunction questionnaire (ETDQ-7), Valsalva maneuver, and tympanogram. ET function was reevaluated 6 weeks post-operative in the form of an ETDQ-7, Valsalva maneuver, and tympanogram.ResultsThe ages of selected patients ranged from 21 to 45 years old with mean ± SD = 30.98 ± 10.24 years old. 52.5% of patients were males. Our results showed a statistically significant postoperative improvement in the Valsalva maneuver and the tympanogram type of both ears compared to preoperative with a p-value < 0.001. Similar results were found regarding the assessment of ET function using ETDQ-7 items and the total score (15.35 ± 4.92 vs 26.12 ± 7.79 respectively) with p-value < 0.001.ConclusionA significant improvement in ET function in the form of tympanogram, Valsalva maneuver, and total ET dysfunction questionnaire score, following endoscopic sinus surgery in adult patients with CRS with or without sinonasal polyposis.

How Much is Too Much? Evaluation of the Clinical Relevance of Routine Preoperative Investigations in American Society of Anaesthesiologist (ASA) Grades I and II Patients Undergoing Minor to Intermediate Elective Surgeries at Tertiary Care Teaching Hospital - Influence on Change in the Surgical Plan and Outcome

Abstract Background: In recent decades, experts have questioned the necessity of routine preoperative investigations due to their limited influence on perioperative management, higher expenses, postponed surgical procedures, patient anxiety resulting from false-positive results for minor operations and increased workload for laboratories. Objective: Our objective was to systematically evaluate the impact of pre-operative investigations on the treatment of patients opting for elective procedures. The study aimed to evaluate the impact of pre-operative investigations and peri-operative management on elective surgeries of the American Society of Anesthesiologists (ASA) physical status classification grades I and II, identifying common inappropriate investigations and assessing the impact of abnormal results on patient management. Materials and Methods: We conducted a prospective, cross-sectional, clinical, observational, single-centre study from February 2020 to March 2021 on 500 cases in the General Surgery Department of Tertiary Care Teaching Hospital. This study assessed the importance of pre-operative investigations in low-risk patients undergoing low-grade elective general surgical procedures. We recruited consecutive patients from the surgery wards of the institute, who fulfilled the inclusion criteria and obtained informed written consent for anaesthesia, surgery and participation in the study. Demographic data, the type of investigation conducted and test results were noted. We followed up with patients who had abnormal test results to record the consequences of the abnormality, such as the postponement of surgery and the requirement for additional investigations. Pre-operative transfusion, change in the management plan and change in the anaesthesia plan were recorded. Results: In the current study, the age of the patients ranged from 20 years to 45 years, and the mean age of the patients was 32.208 ± 9.16. The age group of 20–30 years was the commonest, being 158 (31.6%) patients. Out of 500 patients, 296 (59.2%) patients were males and the remaining 204 (40.8%) were female patients. Out of 500 tests, 44 (8.8%) had abnormal results. Most of the changes in our study were based on abnormal ECG findings. Out of a total of 500 surgical procedures performed, 497 (99.4%) were carried out without any difficulty, with two (0.4%) postponed due to abnormality in the pre-operative investigations and one (0.2%) cancelled. A total of 490 (98%) patients did not have any post-operative complications. Only ten (2%) patients developed post-operative complications, and out of those, only one (0.1%) had some abnormality in the pre-operative investigations. Conclusion: Preoperative laboratory investigations do not significantly influence the surgical outcome of the patients belonging to ASA grades I and II.

Comparative Study between Quartz Laser Ablation of Prostate (QLAP) and Transurethral Resection of Prostate (TURP)

Abstract Background &amp; Purpose Pulsed beams produced by laser at wavelength of 2140nm which have above 60% absorption by water that result in vapor bubble which has a destructive effect on tissues and atones (jack hummer effect) but with limited coagulation make it suitable for small sized prostate below 60gm and/or bladder neck incision--. This study was conducted to compare the safety and efficacy of transurethral resection of prostate (TURP) versus Quartz Laser Ablation of prostate (QLAP) regarding patient outcome and intraoperative complications. Study Design Prospective, case controlled comparative study. Setting Ain Shams, Shaker and Maadi military hospitals. Subjects We included 100 patients with lower urinary tract symptoms (LUTS) symptoms secondary to benign prostate enlargement (BPE), and classified them two groups: 50 patients treated by monopolar Transurethral Resection of Prostate (TURP) (Group A), and 50 patients treated by Quartz Laser Ablation of Prostate (QLAP) (Group B). Methods All patients were subjected to full history taking, examination, Preoperative laboratory investigations including, Hemoglobin, hematocrit, serum Na and K and serum PSA. Perioperative radiological investigations including, abdominopelvic ultrasound with pre and post void residual urine, transrectal ultrasound to estimate the prostate size and uroflowmetry. Follow up 6 months post operative for any complication, change in IPSS score, serum PSA, urine analysis, post voiding residual and uroflowmetry were evaluated. Results In the studied population, the average age was (68.03 ± 8.2) years. Comparative study between two groups revealed non- significant difference among post-operative urological data. However, there is a significant difference in median value of PVR but not in median difference value. Similarly, there is no statistically significant difference as regard to laboratory findings with an exception to potassium level. Regarding post-operative complications; the early complications rate was (28%), and the late complications rate was (25%). Comparative study between the 2 groups revealed non-significant difference as regards post-operative complications (p &amp;gt; 0.05). Conclusion To conclude, QLAP technique for management of BPH was proven to be effective in decreasing post-operative PSA, prostate size, IPSS total, and PVR. But, both QLAP and Monopolar TURP techniques had the comparable safety and complications rates.

Routine Pre-operative Laboratory Evaluation: Our Experience at an Obstetric and Gynaecological Pre-anaesthetic Check-Up Clinic.

Introduction Laboratory testing is done before surgery to identify body abnormalities that cannot be detected through clinical evaluation alone. Patients going in for low- or intermediate-risk surgeries are often encouraged to undergo a battery of tests as usual. This cross-sectional observational study evaluated the status of routine pre-operative laboratory tests in American Society of Anaesthesiologists (ASA) Grade I, II, and III adults undergoing elective surgery at a maternity hospital, as well as the impact of these tests on the outcome of the pre-anaesthetic check-up (PAC). Methods The present observational study was conducted on 500 patients scheduled for elective surgery under anaesthesia. The procedures included routine gynaecological and obstetric surgeries like abdominal hysterectomy, suction evacuation, laparotomy for ectopic pregnancy, diagnostic biopsy, and lower segment caesarean section, among others. A designated anaesthesiologist gathered information from the completed PAC sheets. As per the standard departmental policy, each patient underwent a clinical examination and routine investigations at the PAC clinic. In addition to demographic and other variables, laboratory test results and any peri-operative interventions performed due to abnormalities were assessed. Investigations already done, asked by anaesthesiologists, and referral services sought were noted. The impact of these investigations on anaesthetic decision-making was noted. Data were expressed in frequencies and percentages and statistically analysed using INSTAT software (GraphPad Prism Software Inc., La Zolla, USA). Results The age and weight of the patients range from 20 to 70 years and 55 to 95 kg. Most patients belonged to ASA Grade II (n=348, 69.6%). Hypothyroidism was the most common abnormal finding (n=122, 22.4%). Anaemia, hypertension, and diabetes were detected in n=8 (1.6%), n=82 (16.4%), and n=34 (6.8%) of patients, respectively. In 488 (97.6%) patients, one or more of the investigations from the list were pending. Based on the results of various preoperative laboratory investigations, 87 (17.4%) patients were advised of multiple specialty opinions before surgery. A total of 453 (90.6%) patients attending the clinic were recommended to review their PACs after their pending investigations and specialist consultations were completed. At the same time, n=41 (8.2%) was found to be fit for surgery, and n=6 (1.2%) was found unfit for surgery and was postponed. Conclusions The incidence of tests with abnormal results was a little high in our study. One reason could be that a particular group of patients is included in the study. Preoperative laboratory investigations substantially increase the costs. Not many patients with abnormal tests may require changes in their peri-anaesthetic management. Nonetheless, laboratory tests can help ensure the patient is in an ideal preoperative condition. Pre-operative laboratory investigations should be advised on a case-by-case basis to avoid inconveniencing the patient, delaying the surgical procedure, and driving up the cost of surgical treatment.

Predicting Superficial Surgical Site Infections: A Study of the Risk Factors and an Assessment Scale From Western India.

Introduction Superficial surgical site infections (SSSIs) are very common nosocomial infections that can complicate a range of surgeries, resulting in increased morbidity and mortality, and an overall decreased benefit of surgical interventions, along with exorbitant expenditure of healthcare resources. An assessment scale could help in the segregation of the high-risk patient population, and appropriate resources could be directed toward them. Methods A prospective observational study was carried out in a tertiary care hospital in Western India with 200 participants. Certain probable preoperative, intraoperative, and postoperative risk factors for SSSIs were assessed for significance of association, and each patient was given a score according to the assessment scale. The predictive power of the scale was calculated. Results Body mass index (BMI), preoperative laboratory investigations, and preoperative hospital stay showed a significant association with the complication. Clean-contaminated wounds had a higher incidence of postoperative SSSIs as compared to clean wounds. Postoperatively, fever and the presence of open drains predisposed the patient to complications. The assessment scale was found to have a positive predictive value of 40.94% and a negative predictive value (NPV) of 86.30%. Conclusion The factors that could significantly prevent the development of SSSIs are normal preoperative laboratory investigations, less than three days of preoperative hospital stay, and avoiding the use of open drains. The high NPV of the assessment scale means that it can be used as a screening tool to segregate high-risk patients.

Does dutasteride reduce the bleeding in transurethral resection of the prostate in patients on antiplatelet drugs?

The aim of this study was to assess the effect of a 4-week dutasteride treatment on reducing the intraoperative and postoperative bleeding, as well as the amount and duration of irrigation required to clear the urine after transurethral resection of the prostate (TURP) ≥50 g in men receiving the antiplatelet drug (APD). This double-blind randomized clinical trial included patients with a prostate size ≥50 g who were indicated for TURP and were already receiving APD. The study was conducted in the Urology Department of Cairo University over a 12-month period. Routine preoperative laboratory investigations were performed in all patients. Moreover, baseline prostate size, serum prostate-specific antigen level, and International Prostate Symptom Score were estimated. The patients were randomly divided into 2 equal groups (groups A and B). Group A, the dutasteride group, received dutasteride (0.5 mg) once daily for 4 weeks. Group B, the placebo group, received a placebo capsule once daily for 4 weeks. Both groups underwent bipolar TURP. Fifteen patients were excluded from the study; 9 patients from group A and 6 patients from group B, either due to drug intolerability or loss follow-up. The mean blood loss was insignificant between the 2 groups immediately after and 24 hours after surgery (Δ hemoglobin: 1.41 ± 0.63 g/dL vs. 1.48 ± 0.54 g/dL, 2.12 ± 0.70 g/dL vs. 2.31 ± 0.78 g/dL, respectively, p = 0.631, p = 0.333; Δ hematocrit: 2.97% ± 1.51% vs. 3.16% ± 1.36%, 4.96% ± 1.87% vs. 5.73% ± 4.39%, respectively, p = 0.610, p = 0.380). However, there were significant differences in duration of indwelling urethral catheter (5.10 ± 0.55 days vs. 5.80 ± 1.79 days, p = 0.048), duration of bladder irrigation (13.60 ± 2.85 hours vs. 16.33 ± 6.62 hours, p = 0.044), and the amount of saline used for bladder irrigation (11.03 ± 2.30 L vs. 13.87 ± 6.13 L, p = 0.046) between group A and group B. respectively. Treatment with dutasteride for 4 weeks before TURP in men receiving APD did not significantly reduce intraoperative or postoperative bleeding after TURP but could significantly reduce the duration of indwelling catheter placement, as well as the duration and amount of saline irrigation.

Assessment of hepatic steatosis before and after laparoscopic sleeve gastrectomy

Background Nonalcoholic fatty liver disease (NAFLD) is the cause of the new epidemic of chronic liver disease. Most patients are asymptomatic and accidentally diagnosed by imaging. Unfortunately, NAFLD can progress to inflammation, NASH, fibrosis, cirrhosis, HCC, decompensated cirrhosis, death, and/or liver transplantation might be required. Laparoscopic sleeve gastrectomy (LSG) has positive effects on the comorbidities associated with obesity. FibroScan and controlled attenuation parameter (CAP) can assess NAFLD non-invasively by measuring an area a hundred times larger than a biopsy sample. Aim To assess hepatic steatosis pre and post LSG by laboratory investigations and imaging (fibroscan and CAP). Methods Thirty patients were included in a prospective observational study according to the inclusion criteria. Full medical history, preoperative laboratory investigations and imaging were recorded. All patients underwent LSG and were followed up for 6 months postoperatively. Data were coded and analysed by using (SPSS) version 29. Results LSG was associated with a significant improvement in the controlled attenuation parameter CAP values, stiffness values and accordingly grades of steatosis and fibrosis as well as a highly significant decrease in BMI, and on follow-up fibroscan 6 months postoperatively. There was a significant improvement in total cholesterol, triglycerides, LDL and HDL. Conclusion LSG is associated with a significant improvement in BMI, lipid profile, CAP measurement and liver stiffness measurements which means improvement of steatosis. In morbidly obese candidates of bariatric surgery, Fibroscan with CAP (using the XL probe) was used as a simple non-invasive tool for detecting steatosis and fibrosis.

The feasibility and safety of one-shot dilatation compared to conventional sequential dilatation in tubeless percutaneous nephrolithotomy: a prospective randomized controlled study

To study the feasibility and safety of One-Shot Dilatation (OSD), versus serial sequential dilatation in tubeless Percutaneous Nephrolithotomy (PCNL). One Hundred and Fifty patients were randomised into two groups; Group A (One-Shot Dilatation), Group B (Serial Dilatation). Twenty-one patients were excluded from the study. Detailed history was taken and full physical examination was performed. Pre-operative routine laboratory investigations were done. Also, non-contrast Computed Tomography of the Urinary Tract (CTUT) and plain urinary tract x-ray were done. Intra-operative assessments of dilatation, total operative, total fluoroscopy and fluoroscopy during dilatation durations were recorded, as well as estimated blood loss. Post-operatively haemoglobin, creatinine levels and CTUT were performed for all patients. Complications, as urinary leakage time, analgesic requirements and hospitalization time were measured. There were statistically significant differences in the intraoperative durations, where Group A had shorter dilatation time, fluoroscopy time during dilatation and total operative time. Group B had a higher complications rate than Group A; 37.9%, 11.3%, respectively. Also, Group B showed haemoglobin drop by 0.44 mg/dl higher than Group A. More doses of analgesia were required for Group B. Hospitalization time and rate of urinary leakage were both in favour of Group A. For patients undergoing Tubeless PCNL, we have concluded that one-shot dilatation seems to be a safer and more feasible technique than Serial dilatation.

Measurement of Parathyroid Hormone Level after Total Thyroidectomy in Prediction of Hypocalcaemia

Background: Parathyroid dysfunction leading to symptomatic hypocalcemia is not uncommon following a total or completion thyroidectomy and is often associated with significant patient morbidity and a prolonged hospital stay. Objectives: To investigate whether postoperative parathyroid hormone level is a parameter to identify hypocalcaemia after total thyroidectomy. Methods: This prospective longitudinal study was carried out with variety of thyroid disorders with indication of total thyroidectomy at BSMMU. Total 103 patient were selected following the inclusion and exclusion criteria. The routine clinical assessment and the preoperative laboratory investigations of the study population were performed before operation. Preoperative and postoperative levels of serum PTH and serum calcium level were measured. Results: Immediate post-operative period 17(16.50%) patients PTH level were low (&lt;14 pg/ ml). The mean PTH in immediate post-operative was 36.79±21.71 pg/ml. Regarding the distribution of the study patients by serum calcium, it was observed that 20.39% patients belonged to low (&lt;8 mg/dl) serum calcium. The mean serum calcium level was 8.47±1.19 (mg/dl) with ranged from 2.1 to 10.6 (mg/dl). Among the study population 11 patient developed symptomatic hypocalcemia. Most 72.7% the patient, symptomatic hypocalcemia developed after 48 hours of operation. Conclusion: Hypocalcaemia after total or completion thyroidectomy is not uncommon in our population. If we measure a single parathyroid hormone level in postoperative period that can reflect early result and help to take necessary measure to avoid hypocalcaemic effect. Low intraoperative PTH levels during thyroid surgery are therefore a feasible predictor of postoperative hypocalcemia. Sir Salimullah Med Coll J 2022; 30: 103-107

Retrospective Analysis on Characteristics of Uterine Smooth Muscle Tumors of Uncertain Malignant Potential—13 Years' Experience

Background: Benign leiomyomas (LM) and malignant leiomyosarcomas (LMS) can be distinguished by increased cellularity with mitotic activity. Uterine smooth muscle tumors of uncertain malignant potential (STUMP) are a group of rare tumors in between, for which there is still no standardized classification, nor any definitive preoperative imaging or laboratory investigations regarding the possible inclusion of STUMP in the differential diagnosis. Methods: In this study, we retrospectively reviewed 6 cases of STUMP, and assessed their pathogenesis, risk factors, and prognostic features. Results: The mean age of STUMP patients was 40.6 years old. No recurrence has been reported in all six cases after more than 3.6 years of follow-up. The mean tumor size was 9.44 cm (range 6.14–12.21). 4 cases (66.7%) with &lt;5 mitoses, 1 case (16.7%) with 5–9 mitoses, and 1 case (16.7%) with &gt;10 mitoses per 10 high-power fields. Immunohistochemical staining for cyclin dependent kinase nhibitor 2A (p16), tumor protein p53 (p53), and Antigen KI-67 (Ki-67) was 100% positive (2/2, 6/6, and 6/6, respectively). The estrogen receptor (ER) expression rate was 50.0% (3/6), and the progesterone receptor (PR) was 33.3% (1/3). There was no correlation between the expression of these biomarkers and mitotic counts or recurrence. Conclusions: The current immunohistochemical biomarkers are ineffective in determining the probability of malignancy in STUMP patients with desire of further fertility. Detection of gene expression profiles or variants using next-generation molecular techniques may aid in disease prediction, diagnosis, treatment, and prognosis.

Structured histopathology and laboratory evidence in nasal polyposis with different pathogenesis

PurposeNon-steroidal anti-inflammatory drugs-exacerbated respiratory disease (NERD), intrinsic asthma, eosinophilic granulomatosis with polyangiitis (EGPA) and odontogenic sinusitis may be associated with nasal polyps. The aim of the study was to compare circulating inflammatory cells and structural histopathology of these groups of nasal polyposis. MethodsWe retrospectively evaluated 71 patients with nasal polyps stratified according to the above-mentioned pathogenesis. All patients underwent preoperative laboratory investigations and primary endoscopic sinus surgery. Surgical specimens were submitted to structured histopathological evaluation. ResultsThe median tissue eosinophil count (cells/HPF) was significantly different between the considered groups of nasal polyposis (p=0.0004). The median of NERD sub-cohort was significantly higher than intrinsic asthma (p=0.0030), odontogenic CRS (p=0.0001) and EGPA ones (p=0.0094). Eosinophilic aggregates positive rate was significantly higher in NERD sub-cohort than in odontogenic CRS (p=0.0072), EGPA (p=0.0497) and asthma (p=0.0188) ones. EGPA sub-cohort had a higher neutrophil infiltrate positive rate than NERD (p=0.0105) and intrinsic asthma ones (p=0.0040). Odontogenic CRS sub-cohort had a higher neutrophil infiltrate positive rate than NERD (p=0.0140) and asthma ones (p=0.0096). EGPA sub-cohort had a higher presence of fibrosis than NERD (p=0.0237) and odontogenic CRS sub-cohort (p=0.0107). Odontogenic sub-cohort had a lower sub-epithelial edema positive rate than NERD (p=0.0028) and asthma (p=0.0149) ones. ConclusionsStructural histopathology may identify nasal polyps histotypes with different morphological patterns. The identified histopathological features can facilitate the recognition of rational therapeutic and follow-up approaches that consider the tissue modifications associated with the response to drugs and surgery.

Complications and predictors of morbidity for hip fracture surgery in patients with chronic liver disease.

Despite the fact that patients with chronic liver disease (CLD) are at increased risk of complications after a fracture of the hip, there remains little information about the risk factors for acute postoperative complications and their overall outcome.The aim of this study was to describe inpatient postoperative complications and identify predictors of postoperative morbidity. Patients with CLD who had been treated for a fracture of the hip between April 2005 and August 2019 were identified from a retrospective search of an intramural trauma registry based in the Northeastern United States. Medical records were reviewed for baseline demographics, preoperative laboratory investigations, and outcomes. The trauma registry contained 110 patients with CLD who had undergone surgery for a fracture of the hip. Of these, patients with a platelet-count of ⩽100,000/µL were 3.81 (95% CI, 1.59-9.12) times more likely to receive a transfusion than those with a platelet-count of >100,000/µL. Those with a Model for End-stage Liver Disease (MELD) score of >9 were 5.54 (2.33-13.16) times more likely to receive a transfusion and 3.97 (1.06-14.81) times more likely to develop postoperative delirium than those with a MELD score of ⩽9.Of patients without chronic kidney disease, those with a creatinine of ⩾1.2 mg/dL were 6.80 (1.79-25.87) times more likely to develop acute renal failure (ARF) than those with a creatinine of <1.2 mg/dL. In a multivariable model, as MELD score was increased, the odds of developing a composite postoperative complication, which included transfusion, ARF, delirium, or deep wound infection, were 1.29 (1.01-1.66). Other tools used to assess surgical risks, Charlson Comorbidity Index, Elixhauser, and American Society of Anesthesiologist scores, were not predictive. Patients with CLD who undergo surgery for a hip fracture have a high rate of postoperative complications which can be predicted by the preoperative laboratory investigations identified in this study and MELD scores, but not by other common comorbidity indices.

The Value of Preoperative Laboratory Investigations in Healthy Individuals Undergoing Elective Cataract Surgeries.

PurposeTo evaluate the number of patients with abnormal preoperative laboratory test results and determine the benefits of these tests in healthy individuals scheduled for elective cataract surgeries.Patients and MethodsThis study was conducted at Songklanagarind Hospital, Thailand. The data were collected from January 1, 2020, to August 31, 2021. The results of laboratory investigations, consisting of a complete blood count (CBC), including hemoglobin (Hb), hematocrit (Hct), and platelet count; chest X-ray (CXR); electrocardiography (EKG); and anti-human immunodeficiency virus (anti-HIV), were evaluated and analyzed. Additional management actions and rates of postponement or cancellation of surgeries were also evaluated.ResultsIn total, 401 participants were enrolled in this study. The rates of abnormal investigation results were 40.2% for EKG, 15.5% for CXR, 12.7% for Hb, 11.7% for Hct, 2.0% for platelet count, and 0.2% for anti-HIV. The preoperative tests that required additional management and postponement/cancellation of surgeries were CXR (5.5% and 1.7%, respectively), EKG (2.5% and 0.5%, respectively), and anti-HIV (0.2% and 0%, respectively). Moreover, age ≥60 years was associated with a significantly higher rate of positive preoperative EKG findings (relative risk, 4.64; p = 0.017).ConclusionThe CBC test was not beneficial as a preoperative laboratory investigation for healthy individuals in any age group who were scheduled for elective cataract surgery. However, EKG, CXR, and anti-HIV test results were valuable. Patients aged ≥60 years were at risk of having positive EKG results that could result in cancellation or postponement of surgery.

Risk Factors Associated with Cholelithiasis during Pregnancy and Postpartum

Gallbladder disease is the most common non-obstetrical cause of maternal hospitalization in the first year postpartum. Many risk factors have been associated with gallbladder disease in pregnancy including body mass index, prenatal weight gain, prenatal physical activity, dietary fat, age, parity, a history of gallbladder disease and the number of previous pregnancies were significant factors related to new gallstones and biliary sludge formation in the pregnant group. The aim of this study is to evaluate the risk factors for gallstones formation in pregnancy and one year after labour. The study included 328 female patients (pregnant or postpartum) divided into two groups; patient group (164 patient) that are pregnant or postpartum patient have gallstones and control group (164 patient) that are pregnant or postpartum patient does not have gallstones. All patients were subjected to full history taking; especially about risk factors predisposing for gallstones, physical examination and pre-operative routine laboratory investigations and imaging as abdominal ultrasound study (U/S). Obesity, young age, history of gallbladder disease and use of estrogen and progesterone are the main risk factors that increase incidence of gallstones during pregnancy or one year postpartum. Use of vit C, iron, drinking coffee and practicing regular physical activity are considered protective factors.

Bilateral leg pain and unilateral calf atrophy caused by polymyositis accompanying lumbar spinal stenosis and disc herniation: a case report

Polymyositis is a subgroup of idiopathic inflammatory myopathies characterized by symmetric proximal limb weakness and chronic skeletal muscle inflammation. We herein report the first case of bilateral leg pain and unilateral calf atrophy caused by polymyositis accompanying lumbar spinal stenosis and disc herniation. A 52-year-old man presented with intermittent claudication and calf pain that had become gradually aggravated during the last 3 months. Magnetic resonance imaging showed spinal stenosis at the L3/4 and L4/5 levels and lumbar disc herniation at the L4/5 level. Preoperative laboratory investigations revealed elevated muscle enzyme concentrations. Magnetic resonance imaging also showed atrophy, fatty degeneration, and edema in both calf muscles. Histological examination showed inflammatory myositis and fibrosis in the perifascicular connective tissues. The patient was diagnosed with polymyositis. We performed decompressive laminectomy at the L3/4 and L4/5 levels and discectomy at the L4/5 level. After administration of prednisolone for 6 months and methotrexate for 3 months, the patient’s bilateral calf pain and abnormal laboratory findings improved. The combination of surgical decompression and adequate medical treatment resulted in a successful recovery. Polymyositis should be suspected in patients with lumbar spinal stenosis or lumbar disc herniation who exhibit increased muscle enzyme concentrations or lower extremity muscle atrophy.

Nephroblastoma cavoatrial tumor thrombus-A challenge to anesthesiologist.

Nephroblastoma cavoatrial tumor thrombus-A challenge to anesthesiologist.

Reoperation rate and implant survivorship compared between cementless and cemented bipolar hemiarthroplasty in femoral neck fracture patients with chronic kidney disease

BackgroundChronic kidney disease (CKD) is commonly associated with aging and disorders of mineral and bone metabolism. Femoral neck fracture (FNF) is one of the most common fractures among older adults with coexisting CKD, and bipolar hemiarthroplasty (BHA) is a preferred treatment. However, the optimal method of stem fixation has not been conclusively determined. Accordingly, this study aimed to investigate the reoperation rate and implant survivorship compared between cementless and cemented BHA in FNF patients with CKD. MethodsA total of 183 FNF patients with moderate to severe CKD who underwent BHA during 2003 to 2019 were recruited and divided into either the cemented (CT group, n = 56) or cementless (CL group, 127) groups. Demographic data, preoperative laboratory investigations, preoperative radiographic outcomes, perioperative outcomes, and 90-day morbidity, mortality, and reoperation rates for any reason were recorded and compared between groups. Kaplan-Meier survival analysis was used to compare implant survivorship between the CT and CL groups. Cox proportional hazards regression model was used to identify independent risk factors for implant survivorship. ResultsThere were no significant differences in patient characteristics or preoperative data between groups, except for Dorr's classification of proximal femoral geometry. The CT group had a significantly lower proportion of Dorr type A (p = 0.020), and a higher proportion of Dorr type C (p<0.001). The CT group also had significantly more intraoperative blood loss (p<0.01). No significant differences in morbidity or mortality were observed. The median follow-up time in the CT group and CL group was 22.6 months (range: 0–151) and 22.6 months (range 0–154), respectively (p = 0.607). The reoperation rate was 5.4% and 4.7% among CT and CL patients, respectively (p = 1.000). There was no significant difference in the mean survival time between the CT (139.5 ± 6.3 months, 95%CI: 127.1–151.8) and CL (142.5 ± 4.7 months, 95%CI: 133.2–151.7) groups (p = 0.880). Univariate and multivariate analyses revealed no independent risk factors for implant survivorship. ConclusionThe results of this study showed no significant differences in the reoperation rate or implant survivorship between cemented and cementless BHA for treating FNF in moderate to severe CKD patients. A well-designed larger and longer-term study is needed to confirm these results.

Effect of Parathyroid Hormone Level within One Hour of Total Thyroidectomy on Serum Calcium Level

Background: Parathyroid dysfunction leading to symptomatic hypocalcemia is not uncommon following a total or completion thyroidectomy and is often associated with significant patient morbidity and a prolonged hospital stay. The current study is designed to evaluate the role of parathormone (PTH) levels detected in a standard time frame after total thyroidectomy as a predictor of post-thyroidectomy hypocalcemia. Objectives: To investigate whether postoperative parathyroid hormone level is a parameter to identify hypocalcemia after total thyroidectomy as well as to find out the optimum cut-off value of parathyroid hormone in early postoperative period. Methodology: This was a cross-sectional study. A total of 103 patients’ male-female with a variety of thyroid disorders with an indication of total thyroidectomy attended the outpatient department and inpatient department of Surgery and Otolaryngology, BSMMU. This study was carried out from March 2018 to September 2019. The routine clinical assessment and the preoperative laboratory investigations were performed before operation. Preoperative levels of serum PTH were measured. Statistical analysis was carried out using SPSS version.22.0. Results: The levels of PTH in the immediate postoperative period showed that 17(16.50%) patients belonged to low PTH (&lt;14). The mean PTH in immediate post-operative was 36.79±21.71 with a range from 0.2 to 111.3. Regarding the distribution of the study patients by serum calcium, it was observed that 20.39% of patients belonged to low (&lt;8 mg/dl) serum calcium. The mean serum calcium level was 8.47±1.19 with ranging from 2.1 to 10.6. In the current study, the scatter diagram showed a positive significant correlation (r=0.310; p=0.001) between PTH and S. Calcium immediate post-operative period. ROC curve for finding the cut-off value of PTH in the immediate post-operative period to predict hypocalcemia among the study population. Conclusion: Hypocalcaemia after the total or completion ....

Evaluation of Different Methods of Treatment of Pilonidal Sinus; a Randomized Controlled Trial

Background: Sacrococcygeal Pilonidal disease is an infection of the skin and subcutaneous tissue at or near the upper part of the natal cleft of the buttocks. This results from chronic infection of hair follicles and subsequent formation of a subcutaneous abscess. Hair then enters the abscess cavity and provokes a foreign body tissue reaction with chronic suppuration and discharge. The aim of this study was the selection of best method of treatment of pilonidal sinus. Patients and methods: This randomized controlled trials was conducted on 56 patients with the diagnosis of pilonidal sinus disease were admitted to the Department of General Surgery, Zagazig University Hospitals from March 2020 to September 2020. The patients were allocated randomly into four groups, each included 14 patients; Group (1): was Conservative method with medical treatment and drainage if needed. Group (2): were operated by Open technique. Group (3): were operated by Limberg flap technique. Group (4): were operated by Karydakis technique. All patients were subjected to history taking, complete clinical examination, preoperative Laboratory investigations. Results: Recurrence was significantly associated with open and conservative groups while there was only one case in Limberg Group and no case in Karydakis Group. Conclusion: The Karydakis flap procedure should be chosen instead of the Limberg flap for treating uncomplicated Sacrococcygeal pilonidal disease because of its shorter operative time, earlier return to work, faster healing time and significantly higher patient satisfaction.

Risk factors for surgical site infection following spinal surgery in Saudi Arabia: A retrospective case-control study.

Surgical site infections (SSIs) are common complications after spinal surgery that result in increased morbidity, mortality, and healthcare costs. It was estimated that SSIs after spinal surgery resulted in a 4-fold increase in health care costs. The reported SSI rate following spinal surgery remains highly variable between approximately 0.5% and 18%. In this study, we aimed to estimate the SSI rate and identify possible risk factors for SSI after spinal surgery in our Saudi patient population.We conducted a single-center, retrospective case–control study in Saudi Arabia that included patients who developed SSIs, while the controls were all consecutive patients who underwent spinal surgery between January 2014 and December 2016. We extracted data on patient characteristics, anthropometric measurements, preoperative laboratory investigations, preoperative infection prevention measures, intraoperative measures, comorbidities, and postoperative care.We included 201 consecutive patients in our study; their median age was 56.9 years, and 51.2% were men. Only 4% (n = 8) of these patients developed SSIs postoperatively. Postoperative SSIs were significantly associated with longer postoperative hospital stays, hypertension, higher American Society of Anesthesia (ASA) scores, longer procedure durations, and the use of a greater number of blood transfusion units.This study revealed a low SSI rate following spinal surgery. We identified a history of hypertension, prolonged hospitalization, longer operative time, blood transfusion, and higher ASA score as risk factors for SSI in spine surgery in our population. As our findings are from a single institute, we believe that a national research collaboration among multiple disciplines should be performed to provide better estimates of SSI risk factors in our patient population.