Does experience with laparoscopic colorectal surgery influence intraoperative outcomes?

Background  This study aimed to define the management and risk factors for intraoperative complications (IOC) and conversion in laparoscopic colorectal surgery, and to assess whether surgeon experience influences intraoperative outcomes. Methods  Consecutive patients undergoing laparoscopic colorectal procedures from 1991 to 2005 were analyzed from a longitudinal prospectively collected database. All patients referred to the four surgeons involved in this study were offered a minimally invasive approach. Patient characteristics, perioperative variables, and surgeon experience data were analyzed and compared. Results  A total of 991 consecutive laparoscopic colorectal procedures were studied. The majority of operations were performed for malignant disease (n = 526, 53%), and most frequently consisted of segmental colonic resections (n = 718, 72%). A total of 85 patients (8.6%) had an IOC. Patients experiencing an IOC had a significantly higher median body weight (75 versus 68 kg, p = 0.0047) and had a higher proportion of previous abdominal surgery (31% versus 20%, p = 0.029). Only 39% of patients suffering an IOC required conversion to open surgery. A total of 126 (13%) cases were converted to open surgery. On multivariable analysis, previous abdominal surgery [odds ratio (OR) 3.40, 95% confidence interval (CI) 1.39–8.35, p = 0.0076] was independently associated with having an IOC and a conversion to open within the same procedure. With increasing experience, individual surgeons were found to operate on heavier patients (p = 0.025), and on patients who had a higher rate of previous intra-abdominal surgery (p < 0.0001). Despite these risk factors, the early and late experience demonstrated no significant difference in terms of IOCs (p = 0.54) and conversion to open surgery (p = 0.40). Conclusions  The majority of IOCs can be managed laparoscopically. With increasing experience surgeons can perform laparoscopic colorectal surgery on a patient population with a greater proportion of previous abdominal surgery and a higher mean body weight without adversely affecting their rates of intraoperative complications or conversion. Oral presentation at the Scientific Session of the Society of American Gastrointestinal and Endoscopic Surgeons, April 12th, 2008, Philadelphia, PA.     

Efficacy of azithromycin versus systemic meglumine antimoniate (Glucantime) in the treatment of cutaneous leishmaniasis

Cutaneous leishmaniasis (CL) treatment is painful, and cosmetic results are often unsatisfying. Azithromycin has been reported to be effective in treatment of CL caused by Leishmania viannia braziliensis. The efficacy of azithromycin was compared with Glucantime in treatment of Old World leishmaniasis. Of 49 patients, 22 received 500 mg/day azithromycin for 5 days/month. Treatment cycles were repeated monthly to a maximum of 4 months; 27 patients received 60 mg/kg intramuscular meglumine antimoniate for 20 days. Both groups were followed up for 16 weeks. In the azithromycin group, 2 patients withdrew because of GI symptoms. The response rates of 20 patients (29 lesions) were as follows: full improvement, 10.3%; partial improvement, 27.6%; and 62.1%, no response. In the glucantime group with 27 patients (58 lesions), these rates were 34.4%, 13.8%, and 51.7%, respectively (P = 0.036). Azithromycin was determined to be not as effective as Glucantime in treatment of Old World CL.     

Evaluation serum levels of Insulin Growth Factor-1 (IGF-1) and its association with clinical parameters in severe COVID-19

Inflammopharmacology - Severe coronavirus disease-2019 (COVID-19) is associated with dysregulated immune response and extreme inflammatory injury. Considering the role of insulin growth factor-1...     

Tumor Size Predicts Malignant Potential in Hürthle Cell Neoplasms of the Thyroid

Background A fine needle aspiration (FNA) diagnosis of a Hürthle cell neoplasm is associated with a 20% risk of malignancy. We sought to determine if the primary tumor size correlated with the risk of malignancy in patients with a preoperative FNA diagnosis of a Hürthle cell neoplasm. Methods Between January 2000 and November 2006, 57 patients underwent a thyroidectomy with a preoperative FNA diagnosis of a Hürthle cell neoplasm. Patient histories, FNA reports, operative notes, and pathology reports were retrospectively reviewed. Statistical analysis was performed. Results The overall rate of malignancy in patients with Hürthle cell neoplasms was 21%. The average tumor size was 3.2 cm, with malignant tumors being significantly larger than benign tumors (5.0 vs. 2.7 cm, p < 0.01). The risk of malignancy directly correlated with tumor size. No malignancies were seen in tumors 2 cm or smaller (0/15). The risk of malignancy was only 13% (6/46) in tumors 4 cm or smaller and increased to 55% (6/11) in tumors larger than 4 cm. All tumors larger than 6 cm were malignant (4/4). Conclusions Tumor size correlates directly with malignant potential in patients with Hürthle cell neoplasms of the thyroid. Among our patients, malignancy was not present in any tumors 2 cm or smaller and was present in all tumors larger than 6 cm. Because the risk of malignancy is greater than 50% in patients with a tumor larger than 4 cm, consideration should be given for an initial total thyroidectomy in these patients. This work was supported in part by Friends of Endocrinology, The Gerald Heller Family Foundation, The Helen and Sanford Diller Foundation, and the Bell Charitable Trust.     

False positive 18F-FDG-PET/CT in a patient after talc pleurodesis

A 61-year-old man presented with spontaneous pneumothorax. After diagnosis of emphysemic bullae, the patient underwent talc pleurodesis and had no further complaints. Five years later a routine chest X-ray showed suspicious pleural lesions in addition to the emphysema, which was deemed compatible with the known history of talc pleurodesis. Subsequent chest CT, however, revealed one lesion in the right lung that appeared not typical for this condition in addition to multiple lesions in pleural proximity. FDG-PET/CT demonstrated high glucose uptake in all the lesions. Subsequent needle biopsy of the suspicious intrapulmonary and also of one mediastinal lesion yielded the histopathological diagnosis of talcum granuloma with long-standing calculous fibrotic changes and no evidence of malignancy. This report on PET/CT after talc pleurodesis addresses the potential pitfalls caused by this condition, as chronic granulomatous reactions, like other inflammatory lesions, may account for highly increased FDG uptake which should be interpreted with caution and not simply read as a sign of malignancy. PET/CT offers the opportunity to exactly localize the areas of increased FDG uptake within regions of pleural thickening caused by talc deposition, however, the dilemma of misleading FDG accumulation cannot be solved by this hybrid imaging modality.     

Restorative role of persimmon leaf (Diospyros kaki) to gamma irradiation-induced oxidative stress and tissue injury in rats

Purpose: To evaluate the efficacy of persimmon leaf extract (PL (as a rich plant source) in modulation of radiation-induced liver injury and some metabolic variations in gamma-irradiated rats.

Materials and methods: PL at a dose of 1000?mg/kg body weight (P₁₀₀₀) was administered to male albino rats via gastric intubation for 15 days after whole body γ-irradiation (6?Gy).

Results: Irradiated rats showed significant decreases in hepatic glutathione content (GSH), superoxide dismutase (SOD), catalase (CAT) and xanthine dehydrogenase (XDH) activities with significant increases in malondialdehyde (MDA) level and xanthine oxidase (XO) activity designating oxidative stress. In parallel significant increases in serum aspartate and alanine transaminase (AST, ALT), alkaline phosphatase (ALP), γ-glutamyl-transferase (GGT) activities and bilirubin content were recorded indicating liver injury. In addition, hyperglycemia, hypoinsulinemia and dyslipidemia (elevated total cholesterol, triglycerides, low density lipoprotein-cholesterol and Atherogenic Index and decreased high density lipoprotein-cholesterol) were recorded. PL treatment has significantly attenuated radiation-induced oxidative stress in hepatic tissues concomitant with significant amelioration of liver function and metabolic disturbances.

Conclusion: It is concluded that PL may have therapeutic potential to alleviate the severity of radiation-induced liver injury, hyperglycemia, hypoinsulinemia and dyslipidemia.     

Genome-Wide Association Studies (GWAS) breast cancer susceptibility loci in Arabs: susceptibility and prognostic implications in Tunisians

Genome-wide Association Studies (GWAS) revealed novel genetic markers for breast cancer susceptibility. But little is known about the risk factors and molecular events associated with breast cancer in Arab Population. Therefore, we designed a broad study to investigate the susceptibility and prognostic implications of the GWAS breast cancer loci in the Tunisian population. In a cohort of 640 unrelated patients with breast cancer and 371 healthy control subjects, we characterized the variation of 9 single nucleotide polymorphisms (SNPs), namely rs1219648, rs2981582; rs8051542, rs12443621, and rs3803662; rs889312; rs3817198; rs13387042 and rs13281615. Only 5 out of 9 GWAS breast cancer loci were found to be significantly associated with breast cancer in Tunisians: The rs1219648 (G vs. A allele: OR?=?1.36, P?=?1?×?10(-3)) and rs2981582 (A vs. G allele: OR?=?1.55, P?=?3?×?10(-6)) of FGFR2 gene; the rs8051542 of the TNRC9 gene (T vs. C allele: OR?=?1.40, P?=?4?×?10(-4)); the rs889312 of the MAP3K1 gene (C vs. A allele: OR?=?1.33, P?=?3?×?10(-3)) and the rs13281615 located on 8q24 (G vs. A allele: OR?=?1.21, P?=?0.03). Homozygous variant genotypes of rs2981582 were strongly related to lymph node negative breast cancer (OR?=?3.33, P?=?6?×?10(-7)) and the minor allele of rs2981582 was associated with increased risk of ER+ tumors (OR?=?1.57, P?=?0.02; OR?=?2.15, P?=?0.001, for heterozygous and homozygous variant genotypes, respectively) and increased risk of distant metastasis development (OR?=?2.30, P?=?4?×?10(-3); OR?=?3.57, P?=?6?×?10(-5), for heterozygous and homozygous variant genotypes, respectively) in a dose dependent manner. The association for rs8051542 was stronger for high-grade SBR tumors (OR?=?2.54, P?=?2?×?10(-4)). GG genotype of rs13387042 on 2q35 showed a significant association with the risk of developing distant metastasis (OR?=?1.94, P?=?0.02). The G allele of rs1219648 in FGFR2 and the A allele of rs13387042 on 2q35 indicated a better prognosis by showing a significantly higher overall survival rates (P?=?0.013 and P?=?0.005, respectively). In conclusion, GWAS breast cancer FGFR2, TNRC9, MAP3K1, and 8q24 loci are associated with an increased risk of breast cancer and genetic variation in FGFR2 gene may predict the aggressiveness of breast cancer in Tunisians.     

Association of toxicochemical and microbiological quality of bottled mineral water in Birjand city,Iran

Water is one of the pivotal, both in natural ecosystems and human development. Inadequate and unsafe water is still one of the major challenges in most developing countries. Due to the growing trends of bottled water (BW) consumption in Iran, especially in dry regions, regular monitoring of the quality of bottled mineral water is necessary. Therefore, this cross-sectional study was carried out to evaluate the chemical and microbiological quality of bottled mineral water which was sold in the markets of Birjand city, Iran in 2015. Samples were selected randomly from 12 most popular brands of national BW in autumn and winter. Then, 12 most popular brands were selected for analysis. Finally, parameters including total hardness, levels of calcium, magnesium, pH, bicarbonate, sulfate, alkalinity, residual chlorine and total and fecal coliforms were examined for each brand. The results of the present study revealed that most of the chemical and microbiological parameters of BW in Birjand city were lower than maximum contaminant levels which are set by Iranian mineral water quality standards and WHO guidelines. Furthermore, total and fecal coliforms were within the standards. Overall, the results of this study revealed that the health status of the bottled mineral water which is sold in the markets of Birjand city was good. But, regular monitoring of the above mentioned parameters would be helpful to improve the water quality and to provide good portable water for the dwellers and very effective to enhance public health on citizens.