Association between reduced physical performance measures and short-term consequences after major emergency abdominal surgery: a prospective cohort study

BACKGROUND

Major emergency abdominal surgery is associated with high morbidity with outcomes worse than for similar elective surgery, including complicated physical recovery, increased need for rehabilitation, and prolonged hospitalisation.

PURPOSE

To investigate whether low physical performance test scores were associated with an increased risk of postoperative complications, and, furthermore, to investigate the feasibility of postoperative performance tests in patients undergoing major emergency abdominal surgery. We hypothesize that patients with low performance test scores suffer more postoperative complications.

METHODS

The study is a prospective observational cohort study including all patients who underwent major abdominal surgery at the Department of Surgery at Zealand University Hospital between 1st March 2017 and 31st January 2019. Patients were evaluated with De Morton Mobility Index (DEMMI) score, hand grip strength, and 30-s chair-stand test.

RESULTS

The study included 488 patients (median age 69, 50.6% male). Physiotherapeutic evaluation including physical performance tests with DEMMI and hand grip strength in the immediate postoperative period were feasible in up to 68% of patients undergoing major emergency abdominal surgery. The 30-s chair-stand test was less viable in this population; only 21% of the patients could complete the 30-s chair-stand test during the postoperative period. In logistic regression models low DEMMI score (< 40) and ASA classification and low hand grip strength (< 20 kg for women, < 30 kg for men were independent risk factors for the development of postoperative severe complications Clavien-Dindo (CD) grade ≥ 3.

CONCLUSIONS

In patients undergoing major emergency surgery low performance test scores (DEMMI and hand grip strength), were independently associated with the development of significant postoperative complications CD ≥ 3.

Laboratory in complicated appendicitis prediction and predictive value of monitoring

OBJECTIVES

The purpose of the study was that monitoring, which is used in diagnosis of acute appendicitis, and laboratory values, were evaluated for verifying diagnosis of complicated appendicitis and these parameters revealed cut-off values in complicated acute/non-complicated appendicitis.

METHODS

195 patients, who had had an operation for acute appendicitis between January 2012 and March 2015 and who were proved to have acute complicated/non-complicated appendicitis from the results of histopathology consideration, were included in this study. Patients' age, preoperative serum, WBC, CRP, NLR and BT with USG results were evaluated.    RESULTS: Among the groups, there were no meaningful differences in the sense of age. Meaningful difference was obtained in between (p > 0.05), WBC, NLR, CRP and appendix diameter values.Serum in WBC >13800 (AUC = 0.614, p = 0.006, %95 GA: 0.541-0.682), in NLR > 4.87 (AUC = 0.641, p = 0.001, %95 GA: 0.569-0.708), in CRP > 5.98 (AUC = 0.651, p 11 mm (AUC = 0.630, p = 0.002, %95 GA: 0.558-0.698) values were obtained. The values that were obtained, were confirmed to be descriptive in analysis of complicated appendicitis and non-complicated appendicitis.According to the obtained cut-off values, serum WBC, diameter of appendicitis, NLR and CRP values', (OR) ratios were calculated for complicated appendicitis by being classified (odds ratio respectively; 3.103 (1.713-5.621), 2.765 (1.496-5.109), 3.025 (1.665-5.494), 2.313 (1.295-4.130)).

CONCLUSION

It is important that treatment options are evaluated to be able to discriminate complicated appendicitis fast and with a high accuracy. In the case that serum WBC is higher than 13800. CRP is higher than 5.98, NLR is higher than 4.87 and appendicitis diameter is longer than 11mm, inflammation of appendicitis is complex with gangrene, perforation and abscess and it emphasizes the suggestion of surgical treatment option to patients (Tab. 4, Fig. 1, Ref. 28).

The impact of the multifocality and subtypes of papillary thyroid carcinoma on central compartment lymph node metastasis

OBJECTIVE

Papillary thyroid carcinoma (PTC) may often appear as multifocal disease. Few studies demonstrated a higher rate of central compartment lymph node metastasis (CCLNM) in multifocal PTC patients. Therefore, the effect of different histological subtypes of multifocal PTC on CCLNM is another subject for further examination. The aim of the present study is to evaluate the rate of central lymph node positivity in multifocal PTC as compared to unifocal disease, and to identify the role of different histologic subtypes of PTC on central neck lymph node positivity.

PATIENTS AND METHODS

Patients with PTC who underwent total thyroidectomy (TT) + central cervical lymph node dissection (CCLND) at authors' institution between January 2012 and June 2016 were included (n=274). Independent Samples t-test, Mann-Whitney U test and Chi-square tests were used to determine univariate associations, and multivariate analysis was conducted by logistic regression.

RESULTS

The rate of CCLND positivity in multifocal PTC is higher than unifocal tumors and the difference is significant (p < 0.05). The univariate analysis demonstrated significant relation with male sex, lymphovascular invasion and size of dominant nodule > 10 mm regarding of CCLND positivity in multifocal PTC patients. The comparison between solitary and mixed histologic subtype of multifocal PTC is also significant (p < 0.05).

CONCLUSIONS

Multifocality is an important risk factor for CCLNM. Male sex, dominant tumor size >10 mm and mixed histological subtype in multifocal PTC may play an important role in CCLND positivity.

The risk of hypoparathyroidism after central compartment lymph node dissection in the surgical treatment of pT1, N0 thyroid papillary carcinoma

OBJECTIVE

The role of central compartment lymph node dissection (CCLND) in the treatment of papillary thyroid carcinoma (PTC) is still controversial. The benefits of CCLND should be weighed against its potential risks. We aim to evaluate the positivity of central lymph nodes in pT1, N0 PTC and to establish the complication rates of total thyroidectomy (TT)+CCLND.

PATIENTS AND METHODS

This is a retrospective study on prospectively collected data over a 45-month period. A total of 329 patients were included. Total thyroidectomy was performed in 130 (39.5%) of these patients due to benign thyroid pathologies, and 199 (60.5%) pT1, N0 PTC patients had TT+CCLND. Our TT technique was applied in the same way in both groups. Central lymph node positivity, the number of lymph nodes removed during CCLND and the operative complications were evaluated. T-test and chi-square analysis were conducted in independent groups for statistical evaluation.

RESULTS

The rate of central lymph node positivity in TT+CCLND group was 38%. The average number of lymph nodes removed by CCLND is 10.2 (1-36). Complication rates between TT and TT+CCLND groups were statistically significant (3.8% vs. 11.1%, respectively) (p<0.05). The difference was found to be particularly more pronounced for transient hypocalcemia. Although there was no significant relation between the number of lymph nodes removed during CCLND and the number of parathyroid glands detected in the pathology specimens (p>0.05), the relation between the development of symptomatic hypocalcemia and the number of the parathyroid glands removed during surgery was significant (p <0.05).

CONCLUSIONS

Central compartment lymph node metastasis in PTC is common. CCLND may increase the rate of transient hypocalcemia.

Incisional hernia treatment with polypropylene graft: results of 10 years

PURPOSE

To report herein our results of tension-free repair of large incisional hernia with polypropylene mesh using a modification of the method that was described by Usher.

METHOD

Two hundred ninety-one patients who were operated on between January 1994 and December 2004 were studied. Two hundred thirty-two patients were female (79.7%), and 59 were male (20.3%). The average follow-up period was 55 months. The patients were evaluated for infection, recurrences, hematoma and seroma formation, sinuses and enterocutaneous fistula formation.

RESULTS

Infection was observed in eight patients (2.7%). Graft removal due to infection was encountered only in two patients (0.6%). Recurrence was observed in six patients (2.1%). Two patients (0.6%) developed hematoma while another two developed seroma. No patient developed enterocutaneous fistula.

CONCLUSION

By using our modified technique we can decrease the expected complications after tension-free repair of large incisional hernias.

Report of a rare case of vocal fold carcinoma that was obscured by a prominent vocal fold polyp

We report the case of a 56-year-old man who was evaluated for hoarseness. Telescopic and fiberoptic examination revealed a huge, pedunculated polyp that obscured the vocal folds. Upon further examination, microlaryngoscopy revealed a coexisting superficial irregular lesion on the upper surface of the left vocal fold, which was identified as a microinvasive carcinoma. This unusual presentation emphasizes the importance of a microlaryngoscopic examination.

Gastric cyst of the oral cavity

A case of a heterotopic gastric cyst of the oral cavity is described and a review of the literature, with emphasis on the possible etiological theories of this rare lesion, is presented. This developmental lesion is found more commonly in males. It most likely arises from misplaced embryonal tissue. Surgical treatment is the preferred choice of treatment, and CO2 laser is a safe alternative surgical approach for the removal of this lesion.

Fine needle aspiration (FNA) cytology in tuberculous lymphadenitis

Sixty-three lymph node aspirates were screened and 32 aspirates revealing granulomatous lymphadenitis with or without caseation necrosis were re-evaluated. The most characteristic morphological features among these cases were epithelioid cell clusters with or without caseation necrosis. When clusters were thick, careful observation of the periphery of the clusters helped to find epithelioid cells. Caseation necrosis revealed a typical macroscopic and microscopic appearance. Ziehl-Neelsen staining was negative in all smears and histological sections. Polymerase chain reaction (PCR) amplification technique was applied to 23 of the cases in which the cytological diagnoses were consistent with tuberculosis. Mycobacterium tuberculosis was demonstrated in 19 (82.60%) cases.

IN CONCLUSION

(i) it is necessary to perform several aspirations from different sites of the enlarged lymph node; (ii) the diagnosis of 'granulomatous lymphadenitis, consistent with tuberculosis' can be given, even though the acid-fast stains are negative; (iii) additional techniques such as PCR give supportive information; (iv) an open biopsy is recommended if there is a discrepancy with the clinical impression.

Pharyngocutaneous fistula following laryngectomy

BACKGROUND

Pharyngocutaneous fistula (PCF) following laryngectomy is a serious complication, and its incidence varies from 7.6% to 50%. Despite the relative frequency of this complication, there is still uncertainty about the predisposing factors.

METHODS

A retrospective study was performed in 295 patients who underwent total laryngectomy.

RESULTS

Of the 295 patients, 37 (12.5%) developed PCF. The contributing factors,--such as early oral feeding postoperatively, prior radiotherapy or tracheostomy, accompanying neck dissection,--and the surgical technique failed to show a statistically significant effect. There was statistically significant association between tumor size and PCF formation. Also, when the suture materials used for the closure of the pharynx were compared, catgut showed a higher rate of PCF formation than vicryl (p < .05).

CONCLUSIONS

The vicryl, when used as a suture material for the closure of the pharynx, seemed to decrease the fistula rate significantly, compared with catgut. Also, tumor stage was found to have a significant role in PCF formation, but no statistical significant difference could be demonstrated for other investigated parameters. We believe that after total laryngectomy, oral feeding can be started at the third postoperative day without increasing morbidity, which makes the patients feel more comfortable and confident without nasogastric tube.

Reflex sympathetic dystrophy following neck dissections

PURPOSE

Reflex sympathetic dystrophy (RSD), which is a disorder that occurs after injury or surgery on the extremities, has not been reported as a complication of neck dissections until now. A group patients with head and neck cancer have been examined to determine the incidence of RSD in neck dissections.

PATIENTS AND METHODS

Forty-six patients with head and neck cancer, who had undergone neck dissections together with the removal of the primary tumor, were evaluated for RSD on their routine controls.

RESULT AND CONCLUSION

The presentation of RSD in two patients who were treated with radical neck dissection is probably a result of sympathetic hyperactivity that is secondary to surgical trauma.

Histologic alterations in the thyroid gland after fine-needle aspiration

To evaluate the histologic alterations due to the fine-needle aspiration (FNA), a comparative study between 20 aspirated and 20 nonaspirated thyroidectomy specimens was performed. The most common findings in the aspirated group were hemorrhage (80%) and vascular proliferation and/or vascular thrombosis (45%). In one of the aspirated cases with the cytologic diagnosis of follicular neoplasm, histologic sections revealed prominent vascular and endothelial proliferation. Fibrosis, cystic degeneration, and infarction were other histologic findings in the aspirated group. Hemorrhage was seen in 45% and cystic degeneration in 25% of the nonaspirated cases. Fifty percent of the nonaspirated cases did not have any additional findings. In conclusion, knowledge of previous FNA application and awareness of possible histologic alterations due to the needling is necessary while evaluating the histologic sections of the thyroidectomy specimens.

Hearing loss in Behçet's disease

In order to determine the characteristics and incidence of hearing loss in Behçet's disease, 72 consecutive cases and 72 sex- and age-matched normal subjects were submitted to this study. Detailed audiologic tests were performed in all cases. Twenty patients (27%) showed some degree of hearing loss; but in only 7 patients (9%) was the average of the frequencies between 500 to 4,000 Hz more than 25 dB hearing level, and the cochlear function of 43 patients (59%) was within the 25-dB range in all frequencies. The averaged pure tone audiograms of the two groups showed a statistically significant hearing loss in the Behçet's group. No relationship could be found between hearing loss and other system involvements. There was no correlation between hearing loss and duration of the disease, but the mean age of the Behçet's patients with hearing loss was found to be significantly higher than the mean age of the patients without hearing loss.

Serum levels of tumor necrosis factor in squamous cell carcinoma of the head and neck

PURPOSE

Tumor necrosis factor (TNF)-alpha is a multifunctional cytokine that influences the clinical outcome in a number of diseases. This study was undertaken to evaluate its role in the differential diagnosis of malignant and benign tumors and in the follow-up of patients. We also studied the correlation of TNF-alpha levels with the stage and differentiation of the diseases.

METHODS

In this study, serum levels of TNF-alpha are determined by the immunoradiometric assay method in 26 patients with head and neck cancer, and results are compared with 8 control patients with benign diseases. In both groups, serum samples were taken before and after the therapy. After centrifugation, the sera was stored at -70 degrees C until analyzed. TNF-alpha levels were measured by TNF-alpha immunoradiometric assay (IRMA) kit (Medgenix, Diagnostics SA, Belgium).

RESULTS

The pretreatment mean value of TNF-alpha in the study group (814.1 pg/mL) was almost 100 times higher than in the control group (8.6 pg/mL) (P = .001). It was also noted that posttreatment mean value (94 pg/mL) was significantly lower than pretreatment mean value in the study group (P = .001). No statistically significant difference was found between serum TNF-alpha levels and the stage and differentiation of the tumor.

CONCLUSION

The serum levels of TNF-alpha may be an efficient tumor marker in the diagnosis of patients with head and neck cancer.

Acyclovir in the treatment of recurrent respiratory papillomatosis: a preliminary report

INTRODUCTION

In this study, we evaluate the effect of acyclovir in the treatment of recurrent respiratory papillomatosis (RRP), in addition to CO2 surgery.

MATERIALS AND METHODS

We include 12 patients who had aggressive RRP and required at least three prior endoscopic surgeries in this study. Acyclovir treatment started the day after the surgery. During the planned treatment period of 6 months, patients older than 5 years were asked to take the daily dose of 800 mg, and those younger than 5 years were asked to take 400 mg.

RESULTS

Nine of 12 patients were disease free during the follow-up periods, which ranged from 14 to 25 months with a mean of 18 months. Only 3 patients who used the drug inadequately required reoperation.

CONCLUSION

Because of the specific viral origin of RRP, we hope that addition of acyclovir to surgery will preclude or at least decrease the number of recurrences in this potentially fatal disease.

Changes of middle ear mucosa in secretory otitis media treated with ventilation tubes

The present study was designed to obtain the precise ultrastructural status of the middle ear mucosa of patients to whom ventilation tubes were applied for the treatment of secretory otitis media (SOM). This study comprised 14 children with SOM aged 5-11. Normal epithelium obtained from otosclerotic patients as controls was composed of three main cell types; basal, ciliated, and secretory. Electron microscopic observations revealed that ciliated cells were almost completely absent in the epithelium of patients with SOM. Secretory cells, on the other hand, were noted to be increased in number with cytoplasmic features indicating active secretory phase; abundant secretory granules in these cells featured both serous and mucoid characteristics. Following the application of ventilation tubes, the micrographs exhibited a vast number of ciliated cells. Furthermore, the secretory cells were less conspicuous and the secretory granules were mostly serous in type. The ultrastructural findings of this investigation strongly suggest that the application of ventilation tubes in cases of SOM stimulates ciliated cell regeneration, inhibits secretion of mucoid material, and activates serous secretion; all of which eventually shorten the recovery period.