Management of patients with colorectal cancer in COVID-19 pandemic hospital

INTRODUCTION

During the COVID-19 pandemic, both the channelling of manpower into the COVID-19 services and efforts to limit viral spreading of the disease have led to rescheduling and prioritizing oncological cases that are considered as cases of emergency and any postponement of the cases can lead to health problems. In this study, we aimed to show that the surgical treatment of COVID-19 (-) colorectal cancer patients can be performed in a hospital which was declared as a pandemic hospital.

METHOD

In our study, we included patients who underwent surgery for colorectal cancer in the general surgery clinic between the dates 03.20.2020 and 05.20.2020, when the hospital was declared COVID-19 pandemic hospital. Emergency colorectal cancer surgeries such as ileus and perforation were excluded from the study.

RESULTS

While in the status of pandemic hospital, 80 COVID-19 (+) and 563 COVID-19 (+) suspicious patients were treated. Between 10 March 2020 and 15 May 2020, 12 colorectal cancer patients were operated in the General Surgery Clinic of BAIBU Faculty of Medicine, as well.

CONCLUSION

We think that with our study we have shown that during the COVID-19 pandemic, the surgical treatment can be performed for patients with colorectal cancer by eliminating COVID-19 suspicions (Tab. 1, Ref. 14).

Serum amyloid A and Omentin levels in acute appendicitis: a preliminary study for a novel diagnostic approach

BACKGROUND

The diagnosis of acute appendicitis is based on medical history and physical examination. Serum (S) amiloid A (AA) levels are elevated in many inflammatory conditions. Omentin is a recently discovered adipokine showing decreased levels associated with inflammatory conditions. We aimed to measure SAA and omentin levels in patients with acute appendicitis.

MATERIALS AND METHODS

36 patients with a diagnosis of acute appendicitis and 30 healthy subjects were enrolled to this research study. A statistical analysis was performed using IBM SPSS Statistics Version 16.0 (SPSS Inc.®, Chicago, IL, United States).

RESULTS

Patients in study group were significantly older than healthy control subjects (p=0.013). Body mass index of the patients with acute appendicitis (23.2 ± 1.3) was greater than that of the control group (22.7 ± 1), but the difference did not reach the statistically significance (p=0.076). ). Mean level of SAA was significantly raised in study group compared to healthy control subjects (p< 0.001). Mean omentin level was significantly lower in study group compared to healthy subjects (p=0.013).

CONCLUSIONS

In conclusion, although diagnosis of acute appendicitis is mostly based on clinical findings, omentin and especially SAA measurement in serum may help surgeons to avoid negative laparatomy.

Effects of the inflammatory response on serum omentin levels in early acute and chronic pancreatitis

BACKGROUND AND AIMS

Acute pancreatitis is an acute inflammation of the parenchyma of the pancreas. Several adipokines have been investigated in acute pancreatitis, and these cytokines contribute to inflammation in acute pancreatitis. However, not enough data exist regarding omentin in injuries of the pancreas. Because of a possible common pathogenesis, we aimed to study the association between pancreatic damage and serum omentin levels.

MATERIALS AND METHODS

Twenty-four Sprague Dowley rats weighing 200-250 g were randomly placed into three groups: a sham group (n=8), an acute pancreatitis group (n=8), and a chronic pancreatitis group (n=8). Both rats in the sham group underwent laparotomy, and 0.1 cc of saline solution was injected through the pancreatic canal. On the seventh day, a blood sample was obtained by abdominal aorta puncture, and the pancreas was resected for histological examination. In the acute and chronic pancreatitis groups, 0.1 cc of 4.5% Sodium Taurocholote was injected through the pancreatic canal. Blood samples were obtained and pancreatic resection was performed after 24 hours for the acute pancreatitis group and after 7 days for the chronic pancreatitis group.

RESULTS

Serum omentin levels of rats with chronic pancreatitis (49.37±2.82 ng/ml) were increased compared to both acute pancreatitis (37.79±1.24 ng/ml) (p<0.01) and sham rats (22.49±1.4 ng/ml) (p<0.01). In addition, the omentin level of rats with acute pancreatitis was significantly increased compared to the sham group (p<0.01).

CONCLUSIONS

The elevation in omentin levels in rats in the early stage of pancreatitis was due to the anti-inflammatory effects of omentin; hence, elevated omentin levels improved insulin resistance and caused a significant reduction in glucose levels.

Comparison of the effects of bispectral index-controlled use of remifentanil on propofol consumption and patient comfort in patients undergoing colonoscopy

BACKGROUND AND STUDY AIMS

In endoscopic procedures, propofol can be safely administered either alone or in conjunction with remifentanil. The aim of the study is to compare the effects of the administration of propofol alone and the administration of remifentanil in addition to propofol on patient and endoscopist satisfaction, preoperative hemodynamic response, and propofol consumption.

MATERIALS AND METHODS

A totally 60 patients were enrolled in the study. Propofol group (Group 1): A 0.4-mg/kg propofol bolus and 1 mg/kg/h maintenance infusion of propofol until a bispectral Index value of 70-75 was achieved. Propofol + remifentanil group (Group 2) received a 0.4 mg/kg propofol bolus dose and maintained with a 0.5 mg/kg/h infusion of propofol + 0.2 mcg/kg/min infusion of remifentanil. The infusion dose of remifentanil was maintained, and the propofol infusion dose was titrated until a BIS value of 70-75 was achieved.

RESULTS

In Group 1 (colonoscopic intervention 1 and 5 min) and Group 2 (colonoscopic intervention 10 min.), main blood pressure (MBP) value has a significant decrease. Hypotension occurred in 6 patients in group 1, while 12 patients in group 2. No significant difference was found between the Patient's endoscopist' satisfaction, MBP and heart rate. Propofol consumption was greater in group 1 than in group 2. When the Ramsay sedation levels of Group 1 and Group 2 were compared, a statistically significant difference was observed.

CONCLUSIONS

The addition of remifentanil to propofol may be an alternative to the use of alone propofol for sedation in colonoscopic interventions.

Serum omentin levels predicts mesenteric ischemia

BACKGROUND

Acute mesenteric ischemia (AMI) is an intestinal vascular disease with high mortality. Clinical diagnosis of acute mesenteric ischemia is difficult. Adipose tissue is an important mediator of metabolism and inflammation.Omentin is produced by visceral adipose tissue and decreased serum levels of omentin are associated with poor metabolic outcomes. We aimed to investigate whether serum omentin level predicts early diagnosis of AMI before development of transmural ischemia.

METHODS

Twenty-four Sprague Dawley rats weighted about 200-250 gr grouped in 3 experimental groups as sham, transient ischemia and permanent ischemia. Each group consisted of 8 rats. Blood samples were evaluated to determine serum urea, creatinine, omentin and C-reactive protein (CRP) levels. A blinded histological examination performed with the same histologist for hemotoxileneosine painted ileal tissue samples.

RESULTS

Mean serum omentin level in sham group (27.5±4.67) was significantly elevated compared to rats in Ischemia-reperfusion (IR) group (10.9±9.01).The difference reached the statistical significance (p=0.004). Serum omentin levels were not correlated to urea, creatinine or CRPlevels.

CONCLUSION

Omentin levels may be a biochemical indicator to detect AMI. However, further human studies are needed (Tab. 3, Fig. 3, Ref. 34).

Evaluation of the olfactory memory after spinal anesthesia: a pilot study

BACKGROUND

The aim of this study was to investigate the effect of spinal anesthesia (SA) on olfactory memory using Brief-Smell Identification TestTM (B-SIT).

PATIENTS AND METHODS

This, prospective, clinical study was performed on 40 ASA physical status I-III patients, between 18-65 years of age undergoing a planned elective minor surgery under SA. All participants were preoperatively informed about B-SIT and the mode of application of the test according to the information in the book. B-SIT was applied to each patient preoperatively and the scores were recorded. B-SIT was reapplied to all patients on the 1st and 2nd postoperative days and the scores were recorded. Moreover, development of postdural puncture headache (PDPH) and/or neurological symptoms (such as hearing loss, diplopia) were checked.

RESULTS

Postoperative headache was observed in 7 of the participants and 3 of them was diagnosed to have PDPH. No statistically significant difference was observed in the olfactory memory evaluation of the patients suffering from headache and the 3 patients diagnosed with PDPH. No statistically significant difference was observed in the correct odor answer ratio between the preoperative and postoperative 1st and 2nd days (p > 0.05).

CONCLUSIONS

We confirm that SA does not affect olfactory memory. Further studies are necessary to confirm the results of our pilot study in a larger sample.

Mean platelet volume in nasal polyps

BACKGROUND

Many studies in literature point out that inflammation related to nasal polyp is mostly dependent on eosinophils and their inflammatory products. Beside eosinophils, platelets may have a role in nasal polyp development. Platelets are involved in haemostasis, tissue repairing and inflammation. However, to our knowledge, there are no reports in the literature that study the association between platelet parameters and nasal polyps.

SUBJECTS AND METHODS

Forty-three patients with nasal polyps and forty-nine healthy controls were enrolled in the study, retrospectively. Laboratory data of patients with nasal polyp were obtained at the time of diagnosis.

RESULTS

There were no statistically significant differences between the two groups in terms of white blood count, haemoglobin, haematocrit and platelet count. The mean platelet volume (MPV) value of the nasal polyp group was significantly lower than the control group (p = 0.025). Mean eosinophil count was significantly elevated in the nasal polyp group compared to the control group (p < 0.001).

CONCLUSIONS

Reduction in MPV may be an indicator for nasal polyp formation. Further studies with a larger study population are needed to detect the possible correlation between eosinophil count and MPV values in patients with nasal polyps.

A comparison of hand- and foot-activated surgical tools in simulated ophthalmic surgery

OBJECTIVE

To compare the performance characteristics of hand-activated surgical tools with those of foot-activated surgical tools using a virtual-reality simulator of intraocular surgery.

DESIGN

Prospective, unmasked, interventional cohort study.

PARTICIPANTS

Eighteen ophthalmology residents at the University of Toronto.

METHODS

The EYESi ophthalmic surgery simulator was used for the study. The surgical tool evaluated was a simulation of intraocular forceps activated by either a handpiece or a foot pedal. Each resident completed 2 modules-a dexterity module and a capsulorrhexis/cataract module. Each module was completed 4 times, alternating between the hand-activated forceps and the foot-activated forceps. An overall score was calculated for each task on the basis of the efficiency and accuracy of completion of the task, with 100 representing a perfect score. Overall scores were compared between hand and foot control for both modules.

RESULTS

For the dexterity module, there was no significant difference in the overall scores between the 2 groups (91 ± 6 and 93 ± 6 for the foot- and hand-activated forceps groups, respectively; p > 0.05, t test). For the capsulorrhexis module, overall scores were also similar for both groups, the scores being 50 ± 21 and 53 ± 16 for the foot- and hand-activated forceps groups, respectively (p > 0.05, t test). An exit survey of the study's participants revealed that subjects did not have a preference for the hand or foot modality of the forceps tool, with 10 preferring the hand-activated forceps tool and 8 preferring the foot-activated tool.

CONCLUSIONS

During simulated intraocular surgery, foot- and hand-activated surgical tools appear to have similar performance characteristics and are equally well received by residents.

Psychometric properties of a new tool to assess task-specific and global competency in cataract surgery

BACKGROUND AND OBJECTIVE

To establish and validate an assessment tool of cataract surgery performed by residents suitable for a competency-based curriculum.

PATIENTS AND METHODS

A three-component evaluation tool was created based on review of the literature and was refined using a modified Delphi technique. Faculty surgeons viewed two videos of cataract surgery, performed by a novice and an expert, and completed the evaluation tool. Results were analyzed for the psychometric properties.

RESULTS

Evaluators concluded the scale had excellent face validity. Construct validity showed the scale to reliably distinguish (P < .001) between novice (30.3 ± 6.1) and experienced (48.3 ± 7.2) surgeons. Internal consistency of the scale was high, with Cronbach's alpha equal to 0.981. Inter-rater reliability was high with an intraclass correlation coefficient equal to 0.811 (F(df) = 53.2 (25), P < .001).

CONCLUSION

The tool has excellent face validity, content validity, and reliability. Its task-specific, global-index scale and quantitative data form make it a valuable tool to assess residents' surgical skills.

Primary piggyback implantation of 3 intraocular lenses in nanophthalmos

We present a patient with bilateral nanophthalmos who had uneventful cataract extraction in the right eye with primary implantation of 3 intraocular lenses (IOLs) of 2 different materials: a 30 diopter (D) acrylic IOL and a 9 D silicone IOL in the capsular bag and a 30 D silicone IOL in the ciliary sulcus. Subsequently, cataract extraction was done in the left eye with bag-sulcus implantation of two 30 D silicone IOLs. The use of 3 IOLs in 1 eye was necessary because the highest available power of acrylic and silicone IOLs at our institution was 30 D. The only short-term complications were temporary corneal edema and partial displacement of the sulcus IOL anterior to the iris in the right eye and bilateral posterior capsule opacification. The late complication of interlenticular opacification was not present 1 year after piggyback IOL implantation.

Outcomes of repeat penetrating keratoplasty and risk factors for graft failure

PURPOSE

To compare repeat penetrating keratoplasty (PKP) with primary PKP with respect to patient characteristics, survival rates, and risk factors for graft failure.

METHODS

Retrospective, consecutive, noncomparative case series of 116 patients who underwent repeat PKP and who were identified from a cohort of 696 PKPs performed by one surgeon over a 7.5-year period.

RESULTS

Compared with patients who underwent primary PKP, regraft patients were 5 years older, had a higher rate of peripheral anterior synechiae (PAS), were more likely to require intraocular pressure (IOP)-lowering medications prior to surgery, were more likely to develop postoperative corneal neovascularization, were less likely to be phakic, and were more likely to undergo PKP in conjunction with a lens procedure. There was no difference between the two groups with respect to the distribution of original diagnoses leading to PKP and the rate of graft rejection. Two- and 5-year survival rates for repeat PKP were 63.9% and 45.6%, respectively. In a multivariate analysis, the original diagnosis leading to corneal transplantation, the presence of preoperative PAS, intraoperative anterior vitrectomy, and postoperative corneal neovascularization were identified as risk factors for graft failure in patients undergoing a regraft.

CONCLUSIONS

Patients undergoing PKP for the first and second time share common risk factors for graft failure, namely, the original diagnosis leading to corneal transplantation, the presence of preoperative PAS, and the occurrence of postoperative corneal neovascularization. The difference in graft survival rates between the two groups can be partially explained on the basis of higher rates of the latter two risk factors among regrafts.

Direct ophthalmoscopy in pediatric emergency care

Thorough knowledge about the basic ophthalmic examination is instrumental in the emergency department (ED) to determine the severity of eye emergencies and to develop a plan for treatment, including the possible need for an ophthalmology consultation. The direct ophthalmoscope is undoubtedly the most practical instrument available to a pediatric emergency physician for ophthalmic examination. However, the information elicited by its use is dependent on the quality of the instrument and the competency of the user. A greater understanding of the range of possibilities of the direct ophthalmoscope as a diagnostic tool will facilitate more efficient care of the pediatric patient.

Corneal graft outcome study

PURPOSE

To determine overall 2- and 5-year corneal graft survival rates and to identify risk factors for corneal graft failure in our patient population.

METHODS

A retrospective chart review of 696 patients undergoing corneal transplantation performed by a single surgeon at The Toronto Western Hospital over a 7.5-year period.

RESULTS

A total of 468 eyes met the inclusion criteria for this study. Overall, the 2- and 5-year graft survival rates were 78.8% and 64.5%, respectively. In a univariate analysis, patient age, gender, history of glaucoma, preoperative diagnosis, type of operative procedure, and postoperative factors all were shown to be significantly associated with graft survival. In a multivariate analysis, six independent predictors of graft failure were identified: preoperative diagnosis, neovascularization of the graft, the presence of peripheral anterior synechiae, gender, occurrence of one or more rejection episodes, and age of the recipient at the time of corneal transplantation.

CONCLUSIONS

Risk of graft failure can vary substantially within a population of patients receiving a corneal transplant. The outcomes of this study concur with the risk factors for corneal graft failure in the literature and can be used as prognostic guidelines for both surgeons and patients.