Investigatıon of the effect of weight loss after laparoscopic sleeve gastrectomy on cobb angle, waist and back pain: a prospective study

BACKGROUND

In many studies, it has been stated that obesity causes severe increases in the risks of disc degeneration, vertebral fracture, low back, and back pain. One of the most effective treatment options for obesity is bariatric surgery.

OBJECTIVES

In this study, the effect of weight loss on these parameters was investigated by evaluating the Cobb angle, low back, and back pain.

SETTING

University Hospital METHODS: A total of 89 patients were included in the study. Laparoscopic sleeve gastrectomy (SG) was performed on all patients. In addition, Cobb angle, height, weight, and body mass index (BMI) measurements were recorded at each visit. Investigating the quality and quantity of low back pain and the loss of function caused by the patients; visual analog scale (VAS), Oswestry Low Back Pain Disability Questionnaire (OLBPDQ), Roland-Morris Disability Questionnaire (RMDQ), and SF-36 Quality of Life Questionnaire (SF36) were administered.

RESULTS

According to the preoperative Cobb angles, the decrease in the 6th month (P = .029) and 12th month (P = .007) measurements after the operation was found to be statistically significant (P < .05), but it was found to be clinically insignificant. When the changes in RMDQ, OLBPDQ, VAS, and SF-36 scores were examined, the decrease in the 6th month (P = .001) and 12th month (P = .001) scores after the operation was found to be significant compared to the preoperative scores (P < .01).

CONCLUSIONS

In this study, weight loss after SG improved for patients with chronic low back and back pain and significantly improved their quality of life.

AB1304 COMPARISON OF CHARACTERISTICS OF PATIENTS WITH IDIOPATHIC GRANULOMATOSIS MASTITIS IN REMISSION AND NON-REMISSION: RESULTS FROM A TERTIARY REFERRAL CENTRE

Background

Idiopathic granulomatous mastitis (IGM) is an uncommon, benign, chronic inflammatory disease of the breast of unknown etiology. Although an ideal treatment regimen is controversial in IGM, the ultimate goal is remission.

Objectives

To compare the clinical, radiological, laboratory and treatment features of patients in remission and non-remission, and assess predictor factors of remission.

Methods

The data of patients who were histopathological diagnosed with IGM between 2010 and 2020 were evaluated retrospectively. The patients were divided into 2 groups as those in complete remission and non-remission. Complete improvement in clinical and physical examination with medical and/or surgical intervention findings at 2 consecutive visits was defined as complete remission. Patients who were not in complete remission including partial remission and refractory to treatment, were defined as non-remission group.

Results

In this study, there were a total of 103 patients with a diagnosis of IGM followed-up in the rheumatology clinic. Of these, 39 (38%) were in remission and 64 (62%) were non-remission. Age, age at symptom onset, comorbidity, pregnancy (ever), disease localization, clinical signs and symptoms, imaging classification, and baseline acute phase reactants and autoimmune markers were similar in the remission and non-remission groups. The use of antibiotics and azathioprine was significantly higher in the remission group than in the non-remission group. However, there was no difference between the groups in terms of breast surgery, use of corticosteroids and methotrexate (Table 1). In the univariable analysis, antibiotic use [OR: 2.55 (95% CI 1.07-6.11)] was found to be a predictor factor of remission.

Table 1.

Characteristics of patients in remission and non-remission

All patientsPatients in remissionPatients not in remissionp valuen= 103n = 39n= 64Age, years38.1 ± 7.139.6 ± 7.837.2 ± 6.50.07Age at symptom onset, years33.5 ± 6.634.4 ± 7.333 ± 6.10.30Comorbidity, n (%) Thyroid disorders4 (3.9)1 (2.6)3 (4.7)1.00 Hypertension2 (2)2 (5)00.14 Diabetes mellitus1 (1)1 (2.6)00.38Pregnancy (ever), positive/total (%)75/77 (97.4)31/32 (97)44/45 (98)1.00Breast localization, n (%) Left47 (45.6)19 (48.7)28 (43.8)0.88 Right36 (35)13 (33.3)23 (35.9) Bilateral20 (19.4)7 (17.9)13 (20.3)Clinical signs and symptoms, n (%) Palpabl mass94 (91.3)35 (89.7)59 (92.2)0.72 Fistula formation37 (38.1)16 (42.1)21 (35.6)0.52 Erythema61 (65.6)23 (65.7)38 (65.5)0.98 Nipple inversion11 (12)2 (5.4)9 (16.4)0.19 Axillary lymph node45 (48)17 (47.2)28 (48.3)1.00 Erythema nodosum10 (9.9)4 (10.3)6 (9.7)1.00 Arthralgia13 (12.6)3 (7.7)10 (15.6)0.36BI-RADS classification*, n (%) 213 (25)7 (35)6 (18.8)0.12 331 (59.6)9 (45)22 (68.8) 46 (11.5)2 (10)4 (12.5) 52 (3.8)2 (10)0Baseline laboratory -CRP (mg/dL)0.75 (1.4)0.75 (1.4)0.73 (1.4)0.77 - ESR (mm/h)23 (28)21.5 (28)25.5 (28)0.39 -ANA (more than or equal 1/100), nα(%)37/69 (53.6)12/25 (48)25/44 (56.8)0.48 -RF, nα(%)12/30 (40)5 /16 (45.5)7/19 (36.8)0.71 -anti-CCP, nα(%)3/12 (25)2/5 (40)1/7 (14)0.52Treatment, n (%) Surgical intervention38 (36.9)16 (41)22 (34.4)0.49 Antibiotics63 (61.2)29 (74.4)34 (53.1)0.03 Corticosteroids93 (90.3)34 (87.2)59 (92.2)0.49 Methotrexate66 (64.1)26 (66.7)40 (62.5)0.67 Azathioprine19 (18.4)11 (28.2)8 (12.5)0.04

* 52 patients with data were evaluated.

α positive/total

Results are given as mean ± SD or median (IQR).

ANA: Antinuclear antibody; anti-CCP: Anti-cyclic citrullinated peptides; BI-RADS: Breast imaging-reporting and data system; RF: Rheumatoid factor

Conclusion

Patients with in remission did not have the distinctive baseline demographic, clinical, laboratory and radiological features that distinguish them from patients with in non-remission. Patients in remission used more antibiotics and azathioprine. Antibiotic use seems to be associated with remission in univariable analysis. However, further studies are needed to evaluate the factors associated with remission in IGM.

Disclosure of Interests

None declared

POS0968 ARE THERE CLUES FOR THE SCREENING OF SPONDYLOARTHRITIS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES?

Background:

SpA is the most frequent extra-intestinal manifestation in patients with IBD (1). Questioning IBD patients in terms of SpA and referring patients to the rheumatology clinic is important for early diagnosis and treatment management.

Objectives:

We aimed to diagnose SpA early by using the DETAIL questionnaire to IBD patients and to compare it with the study validated for each question (2).

Methods:

In the Hacettepe University Gastroenterology Clinic, patients with IBD were questioned for musculoskeletal symptoms between March 2019 and September 2020. For this purpose, a validated DETAIL questionnaire consisting of 6 questions was asked. Patients with at least 1 positive out of 6 questions were consulted in the rheumatology clinic, and patients were evaluated for SpA by physical examination, laboratory, and imaging. For each question in the detection of arthritis in inflammatory bowel diseases (DETAIL) questionnaire, sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio (LR) were calculated.

Results:

217 IBD patients were included in the study. Twenty patients with previously known rheumatologic diseases were excluded from the study. 49 (24%) of the remaining 197 patients had a positive answer to at least one question in the DETAIL query. 39 (20%) of these patients were evaluated in the rheumatology clinic, and 16 (8.1%) of them were diagnosed with SpA (spondylitis: 9, peripheral arthritis: 7) (Figure 1). In the DETAIL questionnaire, two patients answered 5/6 yes, five patients answered 4/6 yes, eleven patients answered 3/6 yes, ten patients answered 2/6 yes, and eleven patients answered 1/6 yes. In the six items of DETAIL, the best performances in discriminating patients affected by SpA were found in the second and fourth questions (LR + 2.9 and 1.57, respectively) (Table 1).

Conclusion:

41% of IBD patients who answered yes to at least one question in the DETAIL questionnaire were diagnosed with SpA. Especially those with sausage fingers or low back pain for at least 3 months seem more likely probability to be diagnosed with SpA. Unlike the validated study, the probability of having diagnosis of SpA was not observed in questions five and six, which questioning the inflammatory back pain parameters. The DETAIL questionnaire may be used as a useful screening tool for the detection of SpA.

References:

[1]Fragoulis GE et al. Inflammatory bowel diseases and spondyloarthropathies: From pathogenesis to treatment. World J Gastroenterol. 2019;25(18):2162-76.

[2]Benfaremo D et al. Multicenter validation of the DETAIL questionnaire for the screening of spondyloarthritis in patients with inflammatory bowel diseases. The Journal of Rheumatology, 2020.

Table 1.

Sensitivity, specificity, positive and negative predictive values, likelihood ratios of the DETAIL questionnaire both in our study and in the other study

DETAIL questionnaireQuestionsSensitivity(%)Specificity(%)Positive predictive value(%)Negative predictive value(%)Positive likelihood ratioNegative likelihood ratioCurrent studyOther studyCurrent studyOther studyCurrent studyOther studyCurrent studyOther studyCurrent studyOther studyCurrent studyOther study1. Have you ever had a finger or a toe and/or another joint swollen and painful for no apparent reason?68.869.634.867.742.34161.587.31.052.160.90.452. Occasionally, has an entire finger or toe becomes swollen, making it look like a ‘sausage’?12.527.495.789.266.745.161.179.22.92.550.910.813. Have you had pain in your heels?43.645.156.586.341.251.659.182.91.013.30.990.644. Have you ever had back pain lasting at least 3 months that was not injury related?7577.452.273.452.248.47590.91.572.90.480.315. Do you have low back pain in the morning and/or after resting that improves with exercise?43.682.356.567.741.245.159.192.21.012.50.990.266. Do you wake up at night because of low back pain?18.854.978.385.437.554.958.185.40.873.71.040.53Figure 1.

Flow chart of IBD patients in the study

Disclosure of Interests:

None declared.

AB0491 THE IMPORTANCE OF MUSCULOSKELETAL SYMPTOM QUESTIONING IN INFLAMMATORY BOWEL DISEASES

Background:

Spondyloarthritis (SpA) occurs in up to 13% of patients with inflammatory bowel disease (IBD) (1). Early diagnosis and treatment of SpA in IBD patients prevents irreversible musculoskeletal diseases.

Objectives:

The aim of this study is to emphasize the importance of questioning musculoskeletal symptoms in patients with IBD.

Methods:

In the Hacettepe University Gastroenterology Clinic, patients with IBD were questioned for musculoskeletal symptoms between March 2019 and September 2020. For this purpose, a validated DETAIL questionnaire (2) consisting of six questions was asked (1. Have you ever had a finger or a toe and/or another joint swollen and painful for no apparent reason? 2. Occasionally, has an entire finger or toe becomes swollen, making it look like a ‘sausage’? 3. Have you had pain in your heels? 4. Have you ever had back pain lasting at least 3 months that was not injury related? 5. Do you have low back pain in the morning and/or after resting that improves with exercise? 6. Do you wake up at night because of low back pain?). Patients with at least 1 positive out of 6 questions were consulted in the rheumatology clinic, and patients were evaluated for SpA by physical examination, laboratory, and imaging. Demographic and clinical characteristics of IBD patients with and without SpA were compared.

Results:

217 IBD patients were included in the study. Twenty patients with previously known rheumatologic diseases were excluded from the study. 49 (24%) of the remaining 197 patients had a positive answer to at least one question in the DETAIL query. 39 (20%) of these patients were evaluated in the rheumatology clinic, and 16 (8.1%) of them were diagnosed with SpA (spondylitis: 9, peripheral arthritis: 7) (Figure 1). There were no significant differences in terms of age, gender, IBD type, duration of IBD, current treatment, fibromyalgia syndrome (FMS) and depression according to Beck depression inventory between patients with IBD with and without SpA (Table 1).

Table 1.

Clinical, demographic characteristics of the IBD patients according to SpA.

IBD with SpAn= 16IBD without SpAn= 23pAge, years, median (IQR)47.03 (27.4)35.9 (14.1)0.052Female, n (%)8 (50)17 (74)0.12IBD disease duration, months, median (IQR)66.7 (70.7)44.8 (70)0.26IBD type, n (%)CD6 (37)11 (48)0.19UC9 (56)12 (52)IC1 (7)Smoking (ever), n (%)10 (62.5)11 (48)0.37HLA-B27 positivity, n (%)2 (12.5)1 (4.3)0.57Current medication, n (%)- Steroid (oral and/or topical)6 (37.5)5 (21.7)0.31- 5-ASA11 (68.8)14 (61)0.61- Immunosuppressants (AZA, MTX)6 (37.5)8 (34.8)0.86- bDMARD2 (12.5)4 (17.4)1FMS, n (%)1 (6.7)3 (13)1Beck depression Inventory, level of depression, n (%)-minimal1 (9)5 (22)0.13-mild8 (73)7 (30)-moderate2 (18)9 (39)-severe02 (9)

Harvey-Bradshaw Index for CD disease activity and Mayo score for UC disease activity were used.

SD: standard deviation, IQR: inter-quartile range

IBD: inflammatory bowel disease; SpA: Spondyloarthritis, bDMARD: biological disease modifying anti-rheumatic drug, CD: Crohn’s disease, UC: Ulcerative colitis, IC: indeterminate colitis; HBI: Harvey-Bradshaw Index ASA: 5-aminosalicylic acid; AZA: azathioprine; MTX: methotrexate; FMS: Fibromyalgia syndrome

Conclusion:

By questioning the musculoskeletal system in IBD patients, 20% of the patients were evaluated in the rheumatology department, and nearly half of these patients (8%) were diagnosed with SpA. The findings point to the importance of musculoskeletal symptom questioning in routine outpatient clinic control in IBD patients.

References:

[1]Karreman MC et al. The prevalence and incidence of axial and peripheral spondyloarthritis in inflammatory bowel disease: a systematic review and meta-analysis. Journal of Crohn’s and Colitis, 2017, 11.5: 631-642.

[2]Di Carlo M et al. The DETection of Arthritis in Inflammatory boweL diseases (DETAIL) questionnaire: development and preliminary testing of a new tool to screen patients with inflammatory bowel disease for the presence of spondyloarthritis. Clinical rheumatology, 2018, 37.4: 1037-1044.

Figure 1

Flow chart of IBD patients in the study

Disclosure of Interests:

None declared.

Transient neurological symptoms after spinal anaesthesia with levobupivacaine 5 mg/ml or lidocaine 20 mg/ml

BACKGROUND

Transient neurological symptoms (TNS) after spinal anaesthesia have been reported most commonly in association with lidocaine, but have been observed with other local anaesthetics. The aim of this prospective, randomized, double-blind study was to investigate the incidence of TNS after spinal anaesthesia with either levobupivacaine or lidocaine.

METHODS

Patients undergoing inguinal hernia, appendectomy, varicose vein or minor orthopaedic operations were included in the study (60 patients; 47 male, 13 female, overall mean age 30 years). All patients had an American Society of Anesthesiologists score of I or II. The patients were randomly assigned to receive spinal anaesthesia with either 20 mg isobaric levobupivacaine (5 mg/ml) or 80 mg isobaric lidocaine (20 mg/ml). Onset of sensory and motor block and side effects were recorded. On post-operative days 1, 2, and 3, patients were interviewed by an investigator blinded to the spinal anaesthetic used. The patients were classified as having TNS if, following recovery from anaesthesia, there was pain in the buttocks, thighs and/or lower limbs.

RESULTS

In the levobupivacaine group, one patient (3.33%) experienced TNS, whereas in the lidocaine group, eight (26.6%) experienced TNS (P=0.002). Maximum times to arrival of sensory blocks were shorter with lidocaine (P<0.001). The levobupivacaine and lidocaine groups did not differ significantly in terms of the highest dermatome included in sensory block or motor block grade.

CONCLUSION

After spinal anaesthesia with levobupivacaine, the incidence of TNS was much less than after lidocaine. However, it appears that TNS may occur in association with levobupivacaine.

Effect of locally administered lornoxicam in the management of low back pain after lumbar epidural anesthesia: a double-blind, randomized, controlled study

AIM

Low back pain after lumbar epidural anesthesia remains an important clinical problem. Possible causes of the back pain associated with epidural anaesthesia are localized trauma, aseptic periosteitis, tendonitis, inflammation of the ligaments, and osteochondritis. Lornoxicam is a new nonsteroidal anti-inflammatory drug (NSAID) that has been shown to be effective and well tolerated in the treatment of postoperative pain. The use of locally administered lornoxicam for the relief of low back pain following lumbar epidural anesthesia has not yet been studied. Thus, the aim of the present study was to investigate the efficacy of lornoxicam in the management of pain after lumbar epidural anesthesia.

METHODS

A total of 60 patients were randomized to receive either treatment with lornoxicam or to receive a control treatment. The Lornoxicam group received 12 ml of 0.5% epidural bupivacaine and 4 ml 1% lidocaine, along with 2 mg lornoxicam for local infiltration. The control group received 12 ml of 0.5% epidural and 4 mL 1% lidocaine alone for local infiltration. Following the initial preoperative evaluation, a blinded investigator assessed pain intensity at 24, 48 and 72 hours postoperatively using a Verbal Rating Scale (VRS).

RESULTS

The overall frequency of low back pain after epidural anesthesia was significantly higher in control-group patients compared to Lornoxicam-group patients during the 3 days studied (26.6% and 6.6%, respectively, P<0.05).

CONCLUSIONS

Our study demonstrated that local administration of Lornoxicam before epidural anesthesia for pilonidal sinus surgery decreased the frequency and severity of low back pain following lumbar epidural anesthesia with lidocaine. In conclusion, local administration of lornoxicam during epidural anesthesia may present a useful option for the relief of post-epidural low back pain.

Patient comfort and surgeon satisfaction during cataract surgery using topical anesthesia with or without dexmedetomidine sedation

PURPOSE

To determine the safety and efficacy of perioperative dexmedetomidine (Dex) sedation on patient comfort and surgeon satisfaction during cataract surgery under topical anesthesia.

METHODS

Forty-four patients having routine clear corneal phacoemulsification surgery under topical anesthesia were included in the study. Patients were randomly divided into two groups: Dex group (n=22) and control group (n=22). Patients in the Dex group were to receive intravenous Dex using an infusion pump and those in the control group were to receive 0.9% saline infusion. Primary outcome measures were patient comfort, surgeon satisfaction, and patient pain perception.

RESULTS

There was no significant difference between the groups in terms of baseline characteristics including age, sex, eye side, pupil diameter, and vital signs (p>0.05 for all). Patient comfort and surgeon satisfaction in Dex group was better than in control group (p=0.042 and p=0.003, respectively). The mean pain perception score was lesser in the Dex group (1.23+-.72) than control group (3.64+/-1.43), (p<0.001). The mean surgical time and intraoperative complications were similar in both groups (p>0.05). There was no significant effect of the Dex sedation on vital signs perioperatively (p>0.05 for all).

CONCLUSIONS

Dex sedation improved patient and surgeon satisfaction and decreased patients' pain perception while undergoing cataract surgery under topical anesthesia. It appears to be a safe and suitable choice of sedation for cataract surgery.