Cervical and back pains are important clinical problems affecting human populations globally. It is suggested that Propionibacterium acnes (P. acnes) is associated with disc herniation. The aim of this study is to evaluate the distribution of P. acnes infection in the cervical and lumbar disc material obtained from patients with disc herniation.
Methods and material
A total of 145 patients with mean age of 45.21 ± 11.24 years who underwent micro-discectomy in cervical and lumbar regions were enrolled into the study. The samples were excited during the operation and then cultured in the anaerobic incubations. The cultured P. acnes were detected by 16S rRNA-based polymerase chain reaction.
Results
In this study, 145 patients including 25 cases with cervical and 120 cases with lumbar disc herniation were enrolled to the study. There was no significant difference in the age of male and female patients (p = 0.123). P. acnes infection was detected in nine patients (36%) with cervical disc herniation and 46 patients (38.3%) with lumbar disc herniation and no significant differences were reported in P. acnes presence according to the disc regions (p = 0.508.). Moreover, there was a significant difference in the presence of P. acnes infection according to the level of lumbar disc herniation (p = 0.028).
Conclusion
According to the results, the presence of P. acnes is equal in patients with cervical and lumbar disc herniation. There was a significant difference in the distribution of P. acnes infection according to level of lumbar disc herniation.
Proteomic and 16S rDNA analysis of disc tissues obtained in vivo.
Objective
To address the controversy of infection as an aetiology for disc disorders through protein profiling.
Summary of background data
There is raging controversy over the presence of bacteria in human lumbar discs in vivo, and if they represent contamination or infection. Proteomics can provide valuable insight by identifying proteins signifying bacterial presence and, also host defence response proteins (HDRPs), which will confirm infection.
Methods
22 discs (15-disc herniations (DH), 5-degenerate (DD), 2-normal in MRI (NM) were harvested intraoperatively and immediately snap frozen. Samples were pooled into three groups and proteins extracted were analysed with liquid chromatography-tandem mass spectrometry (LC–MS/MS). Post identification, data analysis was performed using Uniprotdb, Pantherdb, Proteome discoverer and STRING network. Authentication for bacterial presence was performed by PCR amplification of 16S rDNA.
Results
LC–MS/MS analysis using Orbitrap showed 1103 proteins in DH group, compared to 394 in NM and 564 in DD. 73 bacterial specific proteins were identified (56 specific for Propionibacterium acnes; 17 for Staphylococcus epidermidis). In addition, 67 infection-specific HDRPs, unique or upregulated, such as Defensin, Lysozyme, Dermcidin, Cathepsin-G, Prolactin-Induced Protein, and Phospholipase-A2, were identified confirming presence of infection. Species-specific primers for P. acnes exhibited amplicons at 946 bp (16S rDNA) and 515 bp (Lipase) confirming presence of P. acnes in both NM discs, 11 of 15 DH discs, and all five DD discs. Bioinformatic search for protein–protein interactions (STRING) documented 169 proteins with close interactions (protein clustering co-efficient 0.7) between host response and degenerative proteins implying that infection may initiate degradation through Ubiquitin C.
Conclusion
Our study demonstrates bacterial specific proteins and host defence proteins to infection which strengthen the hypothesis of infection as a possible initiator of disc disease. These results can lead to a paradigm shift in our understanding and management of disc disorders.
To investigate the prevalence of low virulence disc infection and its associations with characteristics of patients or discs in the cervical spine.
Background
Low virulence bacterial infections could be a possible cause of intervertebral disc degeneration and/or back pain. Controversies are continuing over whether these bacteria, predominantly Propionibacterium acnes (P. acnes), represent infection or contamination. However, the current studies mainly focus on the lumbar spine, with very limited data on the cervical spine.
Methods
Thirty-two patients (20 men and 12 women) who underwent anterior cervical fusion for degenerative cervical spondylosis or traumatic cervical cord injury were enrolled. Radiological assessments included X-ray, CT, and MRI of the cervical spine. Endplate Modic changes, intervertebral range of motion, and disc herniation type were evaluated. Disc and muscle tissues were collected under strict sterile conditions. Samples were enriched in tryptone soy broth and subcultured under anaerobic conditions, followed by identification of the resulting colonies by the PCR method.
Results
Sixty-six intervertebral discs were excised from thirty-two patients. Positive disc cultures were noted in eight patients (25%) and in nine discs (13.6%). The muscle biopsy (control) cultures were negative in 28 patients and positive in 4 patients (12.5%); three of whom had a negative disc culture. Seven discs (10.6%) were positive for coagulase-negative Staphylococci (CNS) and two discs were positive for P. acnes (3.0%). A younger patient age and the extrusion or sequestration type of disc herniation, which represented a complete annulus fibrous failure, were associated with positive disc culture.
Conclusions
Our data show that CNS is more prevalent than P. acnes in degenerative cervical discs. The infection route in cervical discs may be predominantly through an annulus fissure. Correlation between these infections and clinical symptoms is uncertain; therefore, their clinical significance needs to be investigated in the future.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
Dialysis-related destructive spondyloarthropathy caused by beta-2 microglobulin (β2M) amyloid deposits in intervertebral discs is a major burden for patients undergoing long-term dialysis. This study aimed to quantify the presence of β2M amyloid deposits in the intervertebral disc tissue of such patients and analyze whether there was a significant correlation between β2M accumulation and the duration of dialysis.
Methods
Two groups of patients who had undergone surgery for degenerative spinal pathologies were selected: the dialysis group (n?=?29) with long-term dialysis and the control group (n?=?10) with no renal impairment. Tissue sections were prepared from specimens of intervertebral disc tissue obtained during spinal surgery and analyzed via histological staining, including immunohistochemistry (IHC) and Congo red.
Results
There was a statistically significant multifold increase of β2M expression in the disc tissue of long-term dialysis patients when compared to non-dialysis patients, as shown by both IHC (0.019?±?0.023 μm2 vs. 0.00020?±?0.00033 μm2, respectively; p?=?0.012) and Congo red staining (0.027?±?0.041 μm2 vs. 9.240?×?10?5?±?5.261?×?10?5 μm2, respectively; p?=?0.047). We also note a moderate strength positive correlation between the duration of dialysis and positive IHC (r?=?0.39; p?=?0.015) and Congo-red staining (r?=?0.42; p?=?0.007).
Conclusions
The problem of β2M amyloidosis in long-term dialysis patients remains unresolved even with predominant use of high-flux dialysis membranes. This highlights the insufficiency of current dialysis modalities to effectively filter β2M.
The existence of latent low-virulence anaerobic bacteria in degenerated intervertebral discs (IVDs) remains controversial. In this study, the prevalence of low-virulence anaerobic bacteria in degenerated IVDs was examined, and the correlation between bacterial infection and clinical symptoms was analysed.
Methods
Eighty patients with disc herniation who underwent discectomy were included in this study. Under a stringent protocol to ensure sterile conditions, 80 disc samples were intraoperatively retrieved and subjected to microbiological culture. Meanwhile, tissue samples from the surrounding muscle and ligaments were harvested and cultured as contamination markers. The severity of IVD degeneration and the prevalence of Modic changes (MCs) were assessed according to preoperative MRI analysis.
Results
Of the 80 cultured discs, 54 were sterile, and 26 showed the presence of bacteria: Propionibacterium acnes (21 cases) and coagulase-negative staphylococci (5 cases). MRI revealed that the presence of bacteria was significantly associated with MCs (P<0.001). However, there was no significant association between bacterial infection and the severity of IVD degeneration (P?=?0.162).
Conclusions
Our findings further validated the presence of low-virulence anaerobic bacteria in degenerated IVDs, and P. acnes was the most frequent bacterium. In addition, the latent infection of bacteria in IVDs was associated with Modic changes. Therefore, low-virulence anaerobic bacteria may play a crucial role in the pathophysiology of MCs and lumbar disc herniation.
To investigate volumetric changes in lumbar disc herniation (LDH) using three-dimensional measurements obtained by magnetic resonance imaging (MRI) and to identify possible factors affecting such changes.
Methods
Between January 2004 and December 2011, 43 patients who underwent conservative treatment for LDH were enrolled. In all, 56 disc levels were investigated. MRI was performed on two or more occasions (minimally, at the initial visit and 6 months later). The volume of each herniated disc was determined. For each patient, disc migration, morphology, initial LDH size, and clinical outcome were evaluated.
Results
The mean volumes of herniated discs at the initial and follow-up visits were 1,304.57 ± 837.99 and 993.84 ± 610.04 mm3, respectively. The mean change in volume from the initial to the follow-up visit was 310.73 ± 743.60 mm3. Volumes decreased at 35 disc levels and increased at 21 levels. The disc containment, the extent of LDH, the initial size of the herniated disc, and the degree of intactness of the posterior longitudinal ligament were significantly correlated with disc resorption and an increase in disc volume (p = 0.01, p = 0.018, p = 0.001, and p < 0.001, respectively). No significant association was evident between disc volumetric change and clinical outcome.
Conclusions
We observed that LDH is a dynamic disease and that a herniated disc is not always spontaneously resorbed, in contrast to what has been reported previously. Alleviation of clinical symptoms can be achieved via conservative treatment even if the volume of the herniated disc changes. Spinal surgeons should not only present an option of initial non-surgical treatment to LDH patients but should also inform them that the LDH may change in size during daily activity or exercise.
Propionibacterium acnes may be considered a new pathogeny for disc degeneration, but its pathological role has remained unclear. This study was designed to determine whether the latent infection of P. acnes was associated with chronic inflammation in degenerated intervertebral discs via quantification of the levels of a series of cytokines and neutrophils.
Methods
Here, 76 degenerated intervertebral discs were harvested from patients with lower back pain and/or sciatica. Discs with and without P. acnes infection were distinguished and identified using anaerobic culture combined with 16S rDNA PCR and histological examination. Then, cytokines of TNF-α, IL-1β, IL-6, IL-8, MCP-1, MIP-1α, and IP-10, and the numbers of neutrophils were quantified and compared. The severity of disc degeneration and the prevalence of Modic changes were also evaluated between discs with and without P. acnes.
Results
After anaerobic culture and PCR examination, 15 intervertebral discs were placed in the P. acnes-positive group. Another 15 discs were selected from the remaining bacteria-free samples and formed a matched P. acnes-negative group. IL-8, MIP-1α, MCP-1, IP-10, TNF-α, and neutrophils were much higher in P. acnes-positive group than that in the matched P. acnes-negative group. However, only IL-8, MIP-1α, and neutrophils were statistically significant. Furthermore, 7 of 15 P. acnes-positive samples were histologically positive and a subgroup analysis suggested that both histological and PCR-positive samples had the highest concentrations of cytokines of IL-8, MIP-1α, TNF-α, and MCP-1 and the greatest numbers of neutrophils. PCR-positive but histologically negative samples showed the second-greatest, and matched P. acnes-negative samples showed the fewest. However, the difference was only statistically significant between samples found positive under both histology and PCR and samples found negative for P. acnes. Finally, P. acnes-positive group had significantly lower height of intervertebral discs and there was a trend with higher proportion of Modic changes in P. acnes-positive group, but without statistical results.
Conclusions
Latent P. acnes infection was associated with chronic inflammation in degenerated intervertebral discs, especially in the samples with visible bacteria in histology, which manifested as increased numbers of cytokines and neutrophils. Discs with P. acnes infection had much severer disc degeneration and P. acnes-associated chronic inflammation may be the reason.
Although measures to reduce and treat the postoperative surgical drain output are discussed, along with the increased interest in causative factors related to the prevention and treatment reported by many studies, these are still controversial.
Methods
A retrospective study was conducted on a consecutive series of 217 patients who had underwent ACCF between January 2016 and March 2017. Patients were categorized based on normal or increased total drain output. These two groups were compared for demographic distribution and clinical data to investigate the predictive factors of increased drain output by multivariate analysis.
Results
The overall incidence rate of increased drain output after ACCF was 16.6%. There are no significant differences in sex, BMI, history of taking aspirin, and ASA classification between the two groups (P?>?0.05). Of the patients with increased drain output, a significantly higher proportion of patients have OPLL in the surgical level, 18 (50.0%) versus 33 (18.2%) (P?=?0.000). The mean age was 60.67?±?8.18 years versus 54.41?±?10.05 years (P?=?0.001). Number of discs involved was 2.42?±?0.50 versus 2.02?±?0.65 (P?=?0.001). Operation time was 112.22?±?16.49 min versus 105.21?±?17.89 min (P?=?0.031). Intraoperative blood loss was 109.86?±?62.02 mL versus 87.83?±?56.40 mL (P?=?0.036). Logistic regression analysis showed that age (OR, 1.075; p?=?0.003), history of smoking (OR, 2.792; p?=?0.021), OPLL in surgical level (OR, 2.107; p?=?0.001), and number of discs involved (OR, 2.764; p?=?0.003) maintained its significance in predicting likelihood of increased surgical drain output.
Conclusions
The occurrence of increased drain output after ACCF is most likely multifactorial and is related to age, history of smoking, OPLL in surgical level, and number of discs involved.
The aims of this study were to assess lumbar multifidus fatigue (LM) and transversus abdominis activation (TrA) in individuals with lumbar disc herniation associated with low back pain.
Methods
Sixty individuals were divided into the lumbar herniation (LHG, n = 30) and control groups (CG, n = 30). Fatigue of the LM was assessed using surface electromyography during the Sorensen effort test, and activation of the TrA with a pressure biofeedback unit. Pain intensity was determined using a visual analog scale and the McGill pain questionnaire. The Oswestry disability questionnaire and the Borg scale for self-evaluating exertion were used to assess functional disability.
Results
Fatigue was significantly more intense and the TrA activation was insufficient (p < 0.01) in individuals with disc herniation relative to the control group. The LHG had mild functional disability and moderate pain. There were differences in the initial exertion self-evaluation between groups, which were not observed in the final exertion evaluation.
Conclusion
Individuals with lumbar disc herniation associated with low back pain have increased fatigue of the LM and decreased activation of the TrA, when compared to the control group.
To clarify the risk factors for complications after diverting ileostomy closure in patients who have undergone rectal cancer surgery.
Methods
The study group comprised 240 patients who underwent a diverting ileostomy at the time of lower anterior resection or internal anal sphincter resection, in our department, between 2004 and 2015. Univariate and multivariate analyses of 18 variables were performed to establish which of these are risk factors for postoperative complications.
Results
The most common complications were intestinal obstruction and wound infection. Univariate analysis showed that an age of 72 years or older (p?=?0.0028), an interval between surgery and closure of 6 months or longer (p?=?0.0049), and an operation time of 145 min or longer (p?=?0.0293) were significant risk factors for postoperative complications. Multivariate analysis showed that age (odds ratio, 3.4236; p?=?0.0025), the interval between surgery and closure (odds ratio, 3.4780; p?=?0.0039), and operation time (odds 2.5179; p?=?0.0260) were independent risk factors.
Conclusions
Age, interval between surgery and closure, and operation time were independent risk factors for postoperative complications after diverting ileostomy closure. Thus, temporary ileostomy closure should be performed within 6 months after surgery for rectal cancer.
To determine if adolescent athletics increases the risk of structural abnormalities in the lumbar spine.
Methods
A retrospective review of patients (ages 10–18) between 2004 and 2012 was performed. Pediatric patients with symptomatic low back pain, a lumbar spine MRI, and reported weekly athletic activity were included. Patients were stratified to an “athlete” and “non-athlete” group. Lumbar magnetic resonance and plain radiographic imaging was randomized, blinded, and evaluated by two authors for a Pfirrmann grade, herniated disc, and/or pars fracture.
Results
A total of 114 patients met the inclusion criteria and were stratified into 66 athletes and 48 non-athletes. Athletes were more likely to have abnormal findings compared to non-athletes (67 vs. 40 %, respectively, p = 0.01). Specifically, the prevalence of a spondylolysis with or without a slip was higher in athletes vs. non-athletes (32 vs. 2 %, respectively, p = 0.0003); however, there was no difference in the average Pfirrmann grade (1.19 vs. 1.14, p = 0.41), percentage of patients with at least one degenerative disc (39 vs. 31 %, p = 0.41), or disc herniation (27 vs. 33 %, p = 0.43). Body mass index, smoking history, and pelvic incidence (51.5° vs. 48.7°, respectively, p = 0.41) were similar between the groups.
Conclusion
Adolescents with low back pain have a higher-than-expected prevalence of structural pathology regardless of athletic activity. Independent of pelvic incidence, adolescent athletes with low back pain had a higher prevalence of spondylolysis compared to adolescent non-athletes with back pain, but there was no difference in associated disc degenerative changes or herniation.
Modic changes (MCs) in vertebral bones are induced by two mechanisms of mechanical factors and infection. As Propionibacterium acnes (P. acnes) have been reported to be associated with LBP. The aim of this study is to evaluate the MCs in patients with disc herniation and positive for P. acnes.
Methods and material
A total of 120 patients with disc herniation surgery were enrolled into the study. The samples were excised during discectomy and then cultured in both anaerobic and aerobic incubations. Gram staining was employed for investigation of all colonies. The cultured P. acnes were detected by 16S rRNA-based polymerase chain reaction (PCR). MCs of baseline MRI were evaluated.
Results
In this study, 120 subjects (69 male and 51 female) with mean age of 43.15 ± 12.62 years were investigated. Sixty disc samples and eight muscle samples were positive for microorganisms. Moreover, 16S rDNA gene was identified in 46 (38.3%) disc samples. Moreover, 36/46 patients with P. acnes in their sample had MCs.
Conclusion
According to the results and presence of 36/46 MCs in patients with lumbar disc herniation, positive for P. acnes suggests that P. acnes can lead to edema on the vertebrae endplates near to infected area.
Posttraumatic syringomyelia (PTS) can occur as a rare complication after traumatic spinal cord injury (tSCI) and in cases of delayed diagnosis could lead to disastrous deterioration of both motor and sensory neurological functions.
Objective
To determine influencing factors causing PTS after tSCI.
Material and methods
In a monocentric retrospective two-arm study all patients who were readmitted as inpatients due to increasing neurological impairment caused by PTS (n?=?107) in the period between 1 October 1997 and 31 December 2012 were compared with a randomised group of tSCI patients without PTS (n?=?1590) over the same time period.
Results
Included in the study were 107 patients with an average age of 30.25 years (86 male and 21 female). The most frequent clinical symptoms were changes in sensitivity, pain perception and muscle strength. Within the PTS group, patients older than 30 years had a shorter interval between the onset of SCI and the diagnosis of PTS (p?<?0.001). Both the study and control groups showed a significant age difference at the time of the accident (p?<?0.001). In addition, the number of completely paraplegic (American Spinal Injury Association impairment scale AIS type A) patients was significantly higher within the PTS group (p?<?0.001) and they also had remission to pedestrians significantly less frequently (p?<?0.001). In addition, in a group comparison significantly different neurological levels of paralysis (p?<?0.001) were observed at the time of discharge. Further results showed that younger patients with complete SCI lesions had a higher risk of developing PTS.
Conclusion
The PTS is a rare but severe complication of tSCI, frequently followed by increasing impairment of sensibility, motor function and the autonomic nervous system. As the prognosis of the disease is highly influenced by the time point of the diagnosis, in suspected cases immediate presentation at a specialized center for paraplegic patients is necessary.
To evaluate and compare the clinical outcomes and hospital costs of using sutureless aortic valves vs conventional stented aortic valves.
Methods
Between 2007 and 2011, 52 elderly patients undergoing aortic valve replacement for aortic stenosis in our center had a sutureless valve inserted. From among 180 patients who had a stented valve inserted during the same period, 52 patients were matched to the sutureless group, based on age, gender, and operation type. We compared clinical outcomes and hospital costs between the two groups.
Results
The sutureless group had a higher Euroscore (logistic Euroscore I) risk (12.8 vs 9.7; p?=?0.02), with significantly shorter aortic cross-clamp (ACC) time (p?<?0.01), cardiopulmonary bypass (CPB) time (p?<?0.01), intensive care unit stay (p?<?0.01), intubation time (p?<?0.01), and overall hospital stay (p?=?0.05). The sutureless group also revealed a significant hospital cost saving of approximately 8200€ (p?=?0.01).
Conclusions
The clinical and hemodynamic outcomes of using the sutureless bioprosthesis were excellent. The reduced ACC and CPB times had a favorable effect on the duration of intubation and intensive care stay, resulting not only in faster recovery and discharge home, but also in a significant hospital cost reduction.
The treatment of symptomatic degenerative disc disease of the lumbar spine in elderly patients by standard surgical methods is often limited due to severe comorbidities (e.g., cardiopulmonary disease, hypertonia, diabetes). Minimally invasive procedures are more acceptable in this population, since they reduce surgical morbidity and the risk of complications. The percutaneous cement discoplasty (PCD) technique was introduced by the authors to treat dynamic (and angular) instability of the symptomatic lumbar segment by injecting bone cement (polymethylmethacrylate, PMMA) into the disc spaces showing vacuum phenomena via a posterolaterally positioned Jamshidi needle. The aim of this article is to describe the indication, method, and clinical results of PCD.
Method
A total of 81 patients were treated with PCD in a tertiary care referral center over a 6-year period. The current study includes the first group of 47 consecutive patients to complete a pre- and postoperative questionnaire booklet regarding leg and back pain using the visual analog scale (VAS) and the Oswestry disability index (ODI) questionnaire.
Results
A total of 130 discs in these 47 patients were treated with PCD. The majority of patients reported a reduction in their lower back and leg pain (69?% and 66?%, respectively; p?p?
Conclusion
Elderly patients with symptomatic dynamic foraminal stenosis and vacuum phenomenon in the intervertebral disc are suitable candidates for PCD, particularly if they represent high-risk patients for open surgery.
The aim of this study was to elucidate the characteristics and predictors of postoperative atrial fibrillation (POAF) from the standpoint of surgical mode.
Methods
Retrospective analysis was carried out on 607 patients who underwent lobectomy or segmentectomy for clinical stage IA lung cancer. We investigated the clinical factors to determine the predictors of the development of POAF.
Results
Of the 607 patients, 443 underwent lobectomy, and 164 underwent segmentectomy. POAF developed in 37 patients. Of these, 34 (7.7%) were in the lobectomy group, and 3 (1.8%) in the segmentectomy group. In the univariate analysis for predictors of POAF, age (p?<?0.01), history of ischemic heart disease (p?=?0.03), FEV1.0% (p?<?0.01) and surgical mode (p?=?0.01) showed significant differences between the groups. The multivariate analysis revealed that increasing age (p?<?0.01, HR 1.059, CI 1.015–1.106), surgical mode (p?=?0.02, HR 5.734, CI 1.350–24.361) and FEV1.0%?<?70% (p?=?0.03, HR 2.182, CI 1.067–4.461) were independent predictors of POAF.
Conclusion
POAF was significantly less following segmentectomy compared with lobectomy.
The use of inter-body device in lumbar fusions has been difficult to validate, only few long-term RCT are available.
Methods
Between 2003 and 2005, 100 patients entered a RCT between transforaminal lumbar inter-body fusion (TLIF) or posterolateral instrumented lumbar fusion (PLF). The patients suffered from LBP due to segmental instability, disc degeneration, former disc herniation, spondylolisthesis Meyerding grade <2. Functional outcome parameters as Dallas pain questionnaire (DPQ), SF-36, low back pain questionnaire (LBRS), Oswestry disability index (ODI) were registered prospectively, and after 5–10 years.
Results
Follow-up reached 93 % of available, (94 %, 44 in the PLF’s and 92 %, 44 in the TLIF group p = 0.76). Mean follow-up was 8.6 years (5–10 years). Mean age at follow-up was 59 years (34–76 years p = 0.19). Reoperation rate in a long-term perspective was equal among groups 14 %, each p = 0.24. Back pain was 3.8 (mean) (Scale 0–10), TLIF (3.65) PLF (3.97) p = 0.62, leg pain 2.68 (mean) (Scale 0–10) 2.90 (TLIF) and 2.48 (PLF) p = 0.34. No difference in functional outcome between groups p = 0.93. Overall, global satisfaction with the primary intervention at 8.6 year was 76 % (75 % TLIF and 77 % PLF) p = 0.85.
Conclusion
In a long-term perspective, patients with TLIF’s did not experience better outcome scores.
In laparoscopic transcystic common bile duct exploration (LTCBDE), the risk of acute pancreatitis (AP) is well recognized. The present study assesses the incidence, risk factors, and clinical impact of AP in patients with choledocholithiasis treated with LTCBDE.
Methods
A retrospective database was completed including patients who underwent LTCBDE between 2007 and 2017. Univariate and multivariate analyses were performed by logistic regression.
Results
After exclusion criteria, 447 patients were identified. There were 70 patients (15.7%) who showed post-procedure hyperamylasemia, including 20 patients (4.5%) who developed post-LTCBDE AP. Of these, 19 were edematous and one was a necrotizing pancreatitis. Patients with post-LTCBDE AP were statistically more likely to have leukocytosis (p?<?0.004) and jaundice (p?=?0.019) before surgery and longer operative times (OT, p?<?0.001); they were less likely to have incidental intraoperative diagnosis (p?=?0.031) or to have biliary colic as the reason for surgery (p?=?0.031). In the final multivariate model, leukocytosis (p?=?0.013) and OT (p?<?0.001) remained significant predictors for AP. Mean postoperative hospital stay (HS) was significantly longer in AP group (p?<?0.001).
Conclusion
The risk of AP is moderate and should be considered in patients with preoperative leukocytosis and jaundice and exposed to longer OT. AP has a strong impact on postoperative HS.
Management of pancreatic cancer is complex, requiring coordination of multiple providers. National Comprehensive Cancer Network guidelines, developed for standardization and quality improvement, recommend a multimodal approach.
Objective
This study analyzed national rates of compliance with National Comprehensive Cancer Network recommendations, assessed factors affecting compliance, and evaluated whether compliance with evidence-based guidelines improved overall survival.
Design
This is a retrospective review of adults diagnosed with pancreatic cancer entered into the National Cancer Database. Patients included had stage I and II pancreatic cancer, and complete data in the database. Patients were classified as compliant if they underwent both surgery and a second treatment modality (chemotherapy, radiation, or chemoradiation). Clinico-pathologic variables were analyzed using univariate and multivariate models to predict overall survival.
Setting
Hospital-based national study population.
Participants
Patients with stage I or II pancreatic cancer.
Main Outcomes and Measures
Compliance with National Comprehensive Cancer Network recommendations, factors affecting compliance, and overall survival based on compliance.
Results
A total of 52,450 patients were included; 19,272 patients (37%) were compliant. Patients were found to be most compliant in the 50–59-year-old range (49% complaint), with decreased compliance at the extremes of age. Male patients were more compliant than female patients (39 vs 34%, p?<?0.0001). Caucasians were more compliant (39%) than African Americans (32%) or other races (32%, p?<?0.0001). Patients treated at academic/research centers were more compliant than patients treated at other facilities (39% compliant, p?<?0.0001). Patients with stage II disease were more compliant compared with stage I disease (43 vs 18%, p?<?0.0001). Compliance was shown to improve overall survival (p?<?0.0001).
Conclusion
Adherence to National Comprehensive Cancer Network guidelines for pancreatic cancer patients improves survival. Compliance nationwide is low, especially for older patients and minorities and those treated outside academic centers. More studies will need to be performed to identify factors that hinder compliance.
The goal of this study was to compare trapeziectomy alone to trapeziectomy associated with a technique of suspensionplasty using the abductor pollicis longus with a minimum of 6 years of follow-up in the treatment of osteoarthritis of the first carpometacarpal joint.
Methods
Our series included 46 trapeziectomies in 35 patients, aged 69 years in average, among which 27 were women. In 27 cases group I, a trapeziectomy alone was performed, and in 19 cases group II, a trapeziectomy associated with an abductor pollicis longus suspensionplasty was performed.
Results
At the last follow-up, the difference between pre- and postoperative Quick DASH was ??36.104 in average in group I and ??38.877 in average in group II p?=?0.7717. The difference between pre- and postoperative pain was ??3.926 in average in group I and ??4.368 in average in group II p?=?0.35. The difference of pre- and postoperative thumb opposition was 0.630 in group I and 0.421 in group II p?=?0.3033. The average difference of pre- and postoperative key pinch was 0.389 in group I and 0.842 in group II p?=?0.3303. No complication was reported.
Conclusions
Our results suggest that it is unnecessary to perform a ligamentoplasty when a trapeziectomy is indicated.
