Trends of the Extra-Hepatic Biliary Cancer and Its Surgical Management: A Cross-Sectional Study From the National Cancer Database

Introduction

Biliary cancers are rare cancers with poor prognoses. In this study, we aimed to evaluate trends in early detection and surgical treatment and approaches in extra-hepatic biliary tract cancers (EBCs) over 13 years in the US.

Methods

The most recent data on patients diagnosed with EBC between 2004 and 2016 were extracted from the National Cancer Database (NCDB). The patients’ demographics (sex, age, race), primary tumor sites, tumor grades and stages, staging modalities, diagnostic confirmation, surgical treatment modalities and approaches, and 90-day mortality were analyzed to determine trends.

Results

Biopsy was the most common staging modality in 63.9% of total 60,291 patients. The bile duct was the primary tumor site (55.0%). Histologic examination was the most common confirmatory diagnostic modality (77.5%). The most common stage was stage II (23%). The most common surgical treatment modality was radical surgery (13.88%). The open surgical approach was used in 27.1% of patients, followed by a laparoscopic approach (4.3%).

Conclusion

EBC showed no significant change in the trends of the stage at diagnosis, treatment modality, and extent of surgical procedures despite advances in surgical diagnostic and therapeutic modalities; however, the total number of cases slightly increased between 2004 and 2016.

Circulating tumor DNA for breast cancer: Review of active clinical trials

BACKGROUND

The new diagnostic concept of liquid biopsy is based on the analysis of circulating tumor cells (CTCs) and cell-free DNA (ctDNA). In addition to providing a more comprehensive view of the tumor characteristics including molecular variations, ctDNA analysis through liquid biopsies may also allow for a non-invasive, rapid, and cost-effective identification of biomarkers for tumor detection and monitoring of tumor progression.

OBJECTIVE

In this review, we summarize key active clinical trial studies involving utilization of ctDNA derived from liquid biopsy in the early and metastatic breast cancer setting. With this, we also provide a brief overview of the potential future implementations of the LB technology and outlining how ctDNA analysis needs to be standardized through the performance of similar clinical studies.

METHODS

A review was conducted on Clinicaltrials.gov to identify active trials related to use of circulating tumor DNA (ctDNA) for breast cancer. Search terms included "breast cancer," "liquid biopsy," and "ctDNA."

CONCLUSION

While LB is gaining traction in many cancer settings, its use in BC is still early and warrants more investigation in breast cancer diagnostic and treatment settings, including early detection of disease recurrence.

Midgut volvulus is a rare cause of intestinal obstruction in adults: A case report

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Midgut volvulus is usually diagnosed in first weeks of life, or even, in many cases, before birth.

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Incidence of midgut malrotation among pediatrics is 1 in 500 livebirths.

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Incidence of adult midgut malrotation is reported between 0.0001% and 0.19%.

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This is case rare presentation in which a 34 year old man was presented. With diagnosis of midgut volvulus underwent laparotomy.

Introduction

The incidence of midgut vovulus is rare in adults. However, a significant number of cases were seen in infant and children.

Presentation of case

We report a case of a 34-year-old male who presented to the emergency room with persistent periumbilical abdominal pain without any other symptoms. Contrast-enhanced CT showed clearly the typical finding of midgut volvulus like whirlpool sign, corkscrew sign, and the superior mesenteric vein to the left of superior mesenteric artery. The patient was planned for Ladd’s procedure and emergency laparotomy performed successfully with an uneventful postoperative recovery.

Discussion

Managing midgut volvulus is based on presentation. In symptomatic cases surgery is the treatment, but in asymptomatic cases, treatment is controversial.

Conclusion

Although midgut volvulus is rare in adults, it should be considered as an intestinal obstruction.

The prevalence of comorbidities among acute burn patients

Introduction

The elderly population in Iran is growing, and more medical comorbidities can be identified, so hospital admissions of burn patients with associated medical comorbidities are expected to rise as well. As these medical comorbidities may affect the prognosis of burn patients, additional health care services are likely to be required. Therefore, the aim of this study was to determine the prevalence of comorbidities among patients with burn injury.

Methods

A retrospective study of all burn patients admitted to the Motahari Burn Hospital, Iran over a 14-month period was conducted. Variables gathered from patients’ medical record files were demographic characteristics, clinical burn features, hospital course, and preexisting comorbidities. The comorbidity score of patients was calculated by using the updated Charlson comorbidity index.

Results

A total of 732 patients were hospitalized, 136 (18.5%) patients had comorbidities, and more than 57% of elderly people (≥61 years) had one or more comorbid conditions. The most common cause of burn injury among the comorbid patients was scald (38.2%) injury. The two most frequent comorbid conditions among all cases were congestive heart failure (25.8%) and diabetes (23.5%), respectively. As patients got older, the Charlson score also increased. There were no significant differences between comorbid and noncomorbid patients in terms of hospitalization period and mortality rate. Those comorbid patients who died had significantly higher Charlson score and larger mean burn sizes compared to surviving comorbid patients; they were also significantly older.

Conclusion

The prevalence of comorbidities in burn patients was 18.5% and among older burn patients rose to 57%. Diabetes and congestive heart failure were the two most common comorbid conditions.

Prefabricated Skin Excision in Face Lift: A Simplified Technique

BACKGROUND

The demand for facial plastic surgery has dramatically been increased in recent years. Over the last decade, numerous methods have been improved for facelift surgery. Despite these modifications, skin excision technique has not changed significantly. In this study, authors have tried to introduce a new technique regarding skin excision at the initial step of facelift surgery.

METHODS

A prospective study from 2012 to 2017 on 52 patients was carried out to apply a new technique for facelift ‘’Prefabricated skin excision method’’ for all eligible patients undergoing facelift surgery. The skin calling for excision was marked by the surgeon, and then, an analgesic drug was administered. Then, excision of the marked part of the skin was performed and afterward the dissection of the superficial musculoaponeurotic system (SMAS) was performed with the direct exposure.

RESULTS

All patients were female, and 50 (96.1%) cases were primary face lift and 2 (3.9%) cases were secondary. There were no complications among the patients.

CONCLUSION

Facilitating the manipulation of deep layer, using this technique led to the further exposure of the surgical site, and more preferable hemostasis was achieved as well.

Outcomes of Biliointestinal Bypass among Iranian Obese Patients

Background  There are several surgical approaches to treat obesity not cured with medical approaches. Each method has its advantages and complications. In here, we have conducted a study to evaluate complications of biliointestinal bypass surgery (BIBP). Methods  A prospective study was conducted in a private hospital from 2002 to 2016. Those patients, not previously operated for morbid obesity, were eligible. Mean follow-up period was 89 months ( ± 54 months; range: 73-108 months). Main outcome measures were weight, BMI (body mass index), concentrations of blood lipids and glucose, liver transaminases, and obesity-related comorbidities and complications. Results  Twenty-three consecutive patients with morbid obesity, including 16 women (69.7%) and seven men (31.3%) with mean age 38.47 ± 10 years (range: 26-57 years) underwent surgery. At the end of follow-up period, a mean BMI reduction of 12.2 kg/m 2 kg/m 2 ( p  < 0.001)] was observed. An excess weight loss (EWL) of 63% ( ± 34) was achieved at the end of the study. Additionally, total cholesterol and triglyceride levels decreased postoperative significantly. The main long-term complications were flatulence (60%), borborygmus (47.8%), mal odorous stool (30.4%), and diarrhea (21.7%). Revision rate was 4.34%. There were no cases with irreversible hepatic injury, deaths due to the surgery, or progressive renal failure. Conclusion BIBP seems to be a safe, easily reversible, and one of valid therapeutic approaches in morbidly obese patients. BIBP has the potential to achieve durable weight loss and offers an improved quality of life.

The Impact of Cosmetic Surgery on Women's Marital Satisfaction and Self-Concept

BACKGROUND

Today, cosmetic surgery is one of the most common procedures worldwide, and its use is increasing. This study aimed to identify the impact of cosmetic surgery on married women's marital satisfaction and self-concept.

METHODS

From January 1st, 2015 to June 6th, 2015, 44 married women operated in a plastic surgery clinic or seeking for a cosmetic surgery and 55 non-applicants as general population were enrolled. ENRICH marital satisfaction questionnaire and Rogers' Self-concept Inventory were used to compare groups.

RESULTS

Operated applicants revealed a significant higher level of satisfaction in comparison with other groups regarding personality, conflict and leisure. Compared to control group, the surgical group had significantly higher satisfaction in marital and familial relationship, friendship, and financial management.

CONCLUSION

It can be drawn that expectation for postoperative positive outcome probably is an important factor affecting high level of marital satisfaction in cosmetic surgery applicants. Furthermore, the self-concept is significant predictor of applying for cosmetic surgery.

The Impact of Cosmetic Surgery on Married Women's Marital Satisfaction and Self-Concept

BACKGROUND

This study aimed to identify the impact of cosmetic surgery on married women's marital satisfaction and self-concept in Tehran.

METHODS

This study was causal-comparative research. The study population consisted of all women having or applying for cosmetic surgery in Tehran over the second half of 2015. Convenient random sampling was used to select the participants. Enriching and Nurturing Relationship Issues Communication and Happiness (ENRICH) marital satisfaction questionnaire and Rogers' Self-concept Inventory were used to collect data.

RESULTS

The study sample included 44 individuals having facial cosmetic procedures, 51 individuals applying for cosmetic surgery and 55 non-applicants (ordinary people). There were significant differences in terms of marital satisfaction and its components between the cosmetic surgery applicants and surgery group and control group. The cosmetic surgery applicants revealed higher levels of satisfaction in comparison with the surgery and control groups regarding the components' personality, conflict and leisure. Considering the component marital relationship, the applicant group had higher satisfaction than control group. With regard to the components financial management and relatives and friends, the applicant group had higher satisfaction, in comparison to the control group. The control group had better self-concept than the surgery and applicant groups.

CONCLUSION

Expectation for postoperative positive outcome is an important factor affecting high level of marital satisfaction in surgery applicants. Furthermore, the component self-concept is also a significant predictor of having or applying for cosmetic surgery.

Laparoscopic Omentopexy, Rectus Sheath Tunneling and Implantation of the Peritoneal Dialysis Catheter Using a Peritoneal Dialysis Port

BACKGROUND

Prophylactic laparoscopic omentopexy is a safe technique to prevent peritoneal dialysis (PD) catheter obstruction. For the first time, we would like to describe a surgical technique in which the omentopexy is done using a single PD port which is used for the omentopexy, PD catheter insertion, and the rectus sheath tunneling of the catheter.

METHODS

The surgical method of the omentopexy using the PD port (US Patent 20170119430) will be thoroughly described. To evaluate the surgical method, we performed the procedure in 15 consecutive patients with chronic renal failure and followed up the patients.

RESULTS

No intraoperative complication was observed. During the follow-up period, catheter flow failure due to omental wrapping was found in none of the patients. No other complication including exit-site infection, peritonitis, or catheter leakage was detected.

CONCLUSION

Using this technique the catheter can not only be implanted through a proper and long rectus sheath, but the omentopexy can also be done without an additional port. This can reduce port-site complications and dialysis fluid leakage.

Conservative versus Surgical Therapy in Managing Patients with Facial Nerve Palsy Due to the Temporal Bone Fracture

Facial nerve paralysis is classified into immediate or delayed-onset palsy, and affected patients should be treated through conservative or surgical therapy. Appropriate treatment is somewhat debated as well as proper time for performing surgery. This study aimed to assess treatment outcome between conservatively and surgically treated groups and to determine the appropriate time of surgery in selected patients for surgery. Twenty-four patients from April 2008 to July 2015 were included. Performing decompression surgery within the first 2 months following the trauma accompanies a better prognosis ( p -value < 0.05). Eleven patients were managed conservatively, and 4 of them demonstrated immediate onset and 7 indicated delayed onset. Nine patients obtained normal nerve function, one patient had partial palsy, and one of them had complete palsy. There was no significant difference in the rate of recovery between types of the treatment ( p -value > 0.05). Decompression surgery is recommended in the first 2 months after the trauma for immediate onset and also complete degeneration on electroneuronography.

Teenage Rhinoplasty

BACKGROUND

Rhinoplasty is among the most popular aesthetic surgical procedures selected by teenagers. When it comes to teenagers' rhinoplasty, almost all surgeons believe that modified techniques should be considered because the nose is still growing. In this article, we prospectively followed teenagers who had undergone septorhinoplasty to assess the safety of procedure and its possible complications.

METHODS

All the patients who were under 18 years old but for those who had a bleeding disorder, allergic rhinitis, and cleft lip nose were included in the study. All the patients were operated by the Senior author through closed rhinoplasty. Age, gender, indication for surgery, postoperative complications, need for revision surgery, postoperative satisfaction, and disturbance in facial growth until puberty were gathered for each of patients.

RESULTS

Of all 40 patients, 38 (95%) patients were female and 2 (5%) patients were male. Mean age and follow up of patients was 16.1±0.8 years and 29.5±12.1 months, respectively. Fourteen (35%) patients had some degrees of nasal obstruction. Thirty-five (87.5%) patients expressed complete satisfaction with their rhinoplasty outcome. None of patients underwent revision rhinoplasty.

CONCLUSION

The study indicates that patients' craniofacial growth was not affected by the procedure, and it seems that septorhinoplasty is safe in teenagers.

Comparison of six outcome prediction models in an adult burn population in a developing country

There are two types of prognostic model - burn-specific and general - to predict mortality risk in burn patients. Most prediction models were devised in developed countries. The aim of this study was to compare the performance of six outcome models in a developing country. In a retrospective cohort study, data of all thermal burned adult patients (age ≥ 18 years) admitted to the Burn Intensive Care Unit (BICU) were collected and then the following six prediction models were used to assess each patient: Acute Physiology and Chronic Health Evaluation (APACHE II), Abbreviated Burn Severity Index (ABSI), Belgian Outcome in Burn Injury (BOBI), the Ryan model, revised Baux and FLAMES model. Discriminative ability and goodness-of-fit of the prediction models were determined by receiver operating characteristic curve analysis and Hosmer-Lemeshow tests. We included 238 patients (mean age: 38.3 ± 18.39 years, average TBSA: 58.27% ± 24.55) in our study; 172 (72.3%) of them were diagnosed with inhalation injury and 178 (72.4%) were intubated. Mortality rate was 69.7%. Deceased patients had significantly higher mean age, %TBSA and number of inhalation injury. The area under the curve of the models was between 64.5 (APACHE II) and 85.9 (ABSI). The best estimation of predicted mortality was obtained with the ABSI model (67.2%).