Treatment of side limb full-thickness prolapse of the side-to-end coloanal anastomosis following intersphincteric resection: a case report and review of literature

Intersphincteric resection (ISR) with coloanal anastomosis is an oncologically safe anus-preserving technique for very low-lying rectal cancers. Most studies focused on oncological and functional outcomes of ISR with very few evaluating long-term postoperative anorectal complications. Full-thickness prolapse of the neorectum is a relatively rare complication. This report presents the case of a 70-year-old woman presenting with full-thickness prolapse of the side limb of the side-to-end coloanal anastomosis occurring 2 weeks after the stoma closure and 2 months after a robotic partial ISR performed with the Da Vinci single-port platform. The anastomosis was revised through resection of the side limb and conversion of the side-to-end anastomosis into an end-to-end handsewn anastomosis with interrupted stitches. This study describes the first case of full-thickness prolapse of the side limb of the side-to-end handsewn coloanal anastomosis following ISR. Moreover, a revision of all reported cases of post-ISR full-thickness and mucosal prolapse was performed.

Impact of COVID-19 infection during the postoperative period in patients who underwent gastrointestinal surgery: a retrospective study

Purpose@#The coronavirus disease 2019 (COVID-19) pandemic has led to significant global casualties. This study examines the postoperative impact of COVID-19 on patients who underwent gastrointestinal surgery, considering their heightened vulnerability to infections and increased morbidity and mortality risk. @*Methods@#This retrospective observational study was conducted at a tertiary center and patients who underwent gastrointestinal surgery between January 2022 and February 2023 were included. Postoperative COVID-19 infection was defined as the detection of severe acute respiratory syndrome coronavirus 2 RNA by RT-PCR within 14 days after surgery. Propensity score matching was performed including age, sex, American Society of Anesthesiology physical status classification, and emergency operation between the COVID-19-negative (–) and -positive (+) groups. @*Results@#Following 1:2 propensity score matching, 21 COVID-19(+) and 42 COVID-19(–) patients were included in the study. In the COVID-19(+) group, the postoperative complication rate was significantly higher (52.4% vs. 23.8%, P = 0.023).Mechanical ventilator requirement, intensive care unit (ICU) admission, and readmission rate did not significantly differ between the 2 groups. The median length of ICU (19 days vs. 4 days, P < 0.001) and hospital stay (18 vs. 8 days, P = 0.015) were significantly longer in the COVID-19(+) group. Patients with COVID-19 had a 2.4 times higher relative risk (RR) of major complications than patients without COVID-19 (RR, 2.37; 95% confidence interval, 1.254–4.467; P = 0.015). @*Conclusion@#COVID-19 infection during the postoperative period in gastrointestinal surgery may have adverse outcomes which may increase the risk of major complications. Preoperative COVID-19 screening and protocols for COVID-19 prevention in surgical patients should be maintained.

Characteristics and outcomes of colorectal cancer surgery by age in a tertiary center in Korea: a retrospective review

Purpose@#Colorectal cancer (CRC) occurs in all age groups, and the application of treatment may vary according to age. The study was designed to identify the characteristics of CRC by age. @*Methods@#A total of 4,326 patients undergoing primary resection for CRC from September 2006 to July 2019 were reviewed. Patient and tumor characteristics, operative and postoperative data, and oncologic outcome were compared @*Results@#Patients aged 60 to 69 years comprised the largest age group (29.7%), followed by those aged 50 to 59 and 70 to 79 (24.5% and 23.9%, respectively). Rectal cancer was common in all age groups, but right-sided colon cancer tended to be more frequent in older patients. In very elderly patients, there were significant numbers of emergency surgeries, and the frequencies of open surgery and permanent stoma were greater. In contrast, total abdominal colectomy or total proctocolectomy was performed frequently in patients in their teens and twenties. The elderly patients showed more advanced tumor stages and postoperative ileus. The incidence of adjuvant treatment was low in elderly patients, who also had shorter follow-up periods. Overall survival was reduced in older patients with stages 0 to 3 CRC (P<0.001), but disease-free survival did not differ by age (P=0.391). @*Conclusion@#CRC screening at an earlier age than is currently undertaken may be necessary in Korea. In addition, improved surgical and oncological outcomes can be achieved through active treatment of the growing number of elderly CRC patients.

Clinical characteristics and oncologic outcomes in patients with preoperative clinical T3 and T4 colon cancer who were staged as pathologic T3

Purpose@#Clinically suspected T4 stage colon cancer from a preoperative exam is often diagnosed as T3 stage colon cancer pathologically after surgery, raising concerns about understaging. The aims of this study were to compare the survival of clinical T3 and T4 colon cancer patients who had received a pathologic T3 stage diagnosis postoperatively. @*Methods@#Patients who were diagnosed with pathologic T3 stage colon cancer postoperatively were reviewed. Patients with clinically suspected T3 or T4 stage cancer on preoperative exam were enrolled in the study. We compared patient demographics and survival of the cT3 and cT4 groups. @*Results@#Out of the 536 patients with pT3 colon cancer, 503 patients were cT3 (93.8%) and 33 patients were cT4 (6.2%) preoperatively. The most common reason for suspected clinical T4 stage cancer was free perforation (78.8%). There were no statistically significant differences between the 5-year overall survival and the total 5-year disease-free survival (DFS) between the cT3 and cT4 groups; however, local recurrence was significantly higher in the cT4 group (local 5-year DFS: 98.6% vs. 84.0%, P < 0.001). Multivariate analysis showed cT stage was associated with local recurrence, but the association was not statistically significant (P = 0.056). @*Conclusion@#Preoperative clinically suspected T4 stage colon cancer showed inferior local recurrence despite a postoperative pathologic diagnosis of T3 stage cancer. It is necessary to address the shortcomings of pathologic exams in the matter of the understaging of T4 colon cancer, and to reinforce the treatment for local control in patients with cT4 colon cancer.

Association between the IL10 rs1800896 Polymorphism and Tardive Dyskinesia in Schizophrenia

Objective@#Interleukin-10 (IL-10) is a major immunoregulatory cytokine and its gene plays a fundamental role in anti-inflammatory and immunosuppressive activity. This study aimed to examine the association between the IL10 gene promoter -1082G/A polymorphism (rs1800896) and tardive dyskinesia (TD) in schizophrenia. @*Methods@#Two hundred and eighty unrelated Korean schizophrenic patients participated in this study (105 TD and 175 non-TD patients). TD was diagnosed using the Research Diagnostic Criteria for TD and Abnormal Involuntary Movement Scale (AIMS). Genotyping was performed by RT-PCR and high-resolution melting curve analysis. @*Results@#The distributions of genotypic frequencies did not differ between patients with and without TD (χ2=4.33, p=0.115). However, allelic frequencies of the two groups were different (χ2=4.45, p=0.035); the A allele frequency was higher in TD. The total AIMS scores of the three genotypes were not different (F=1.33, p=0.266). However, the total AIMS scores of the A allele carrier and the A allele non-carrier were significantly different (t=5.79, p<0.001). Logistic regression analaysis showed that IL10 -1082G/A genotype significantly predicts presence of TD (p=0.045) after adjusting for covariates such as age and treatment duration. @*Conclusion@#This finding suggests that the A allele of rs1800896 may be associated with TD development following a low IL-10 function.

Clinical characteristics and oncologic outcomes in patients with preoperative clinical T3 and T4 colon cancer who were staged as pathologic T3

Purpose@#Clinically suspected T4 stage colon cancer from a preoperative exam is often diagnosed as T3 stage colon cancer pathologically after surgery, raising concerns about understaging. The aims of this study were to compare the survival of clinical T3 and T4 colon cancer patients who had received a pathologic T3 stage diagnosis postoperatively. @*Methods@#Patients who were diagnosed with pathologic T3 stage colon cancer postoperatively were reviewed. Patients with clinically suspected T3 or T4 stage cancer on preoperative exam were enrolled in the study. We compared patient demographics and survival of the cT3 and cT4 groups. @*Results@#Out of the 536 patients with pT3 colon cancer, 503 patients were cT3 (93.8%) and 33 patients were cT4 (6.2%) preoperatively. The most common reason for suspected clinical T4 stage cancer was free perforation (78.8%). There were no statistically significant differences between the 5-year overall survival and the total 5-year disease-free survival (DFS) between the cT3 and cT4 groups; however, local recurrence was significantly higher in the cT4 group (local 5-year DFS: 98.6% vs. 84.0%, P < 0.001). Multivariate analysis showed cT stage was associated with local recurrence, but the association was not statistically significant (P = 0.056). @*Conclusion@#Preoperative clinically suspected T4 stage colon cancer showed inferior local recurrence despite a postoperative pathologic diagnosis of T3 stage cancer. It is necessary to address the shortcomings of pathologic exams in the matter of the understaging of T4 colon cancer, and to reinforce the treatment for local control in patients with cT4 colon cancer.

Transoral Robotic Thyroidectomy: The Overview and Suggestions for Future Research in New Minimally Invasive Thyroid Surgery

PURPOSE OF REVIEW: This journal introduces a overview in depth about the evolution of transoral robotic thyroidectomy, which has been encountering major confrontations in expanding its indications. RECENT FINDINGS: Transoral robotic thyroidectomy (TORT) is one of the newest approaches and draws attention because of its cosmetic excellence. The major advantage of TORT is comparatively smaller flap dissection area than other remote-access methods. The other advantage of TORT is that the wounds of lips fades out over time, and leaves concealed scar near axilla. SUMMARY: TORT can be done safely to the appropriately selected patients by surgeon expertise in robotic thyroidectomy. It might be a potential alternative surgical approach for thyroidectomy to surgeons who are experienced in remote-access robotic surgery.

Ectopic Mediastinal Parathyroid Adenoma in a Patient with Chronic Kidney Disease: A Case Report

We report an ectopic mediastinal parathyroid adenoma in a patient with chronic kidney disease who presented with refractory hypercalcemia. Technetium-99m-sestamibi scintigraphy is a valuable imaging technique for the detection of an ectopic parathyroid adenoma in the mediastinum. The combination of intense contrast enhancement and the identification of a polar vessel on a computed tomography scan will ensure that a radiologist can differentiate a parathyroid adenoma from other pathologies in the mediastinum. By virtue of the advancement of imaging modalities, localization of an ectopic mediastinal parathyroid adenoma prior to surgery is possible and unnecessary neck exploration is avoidable.

Combining levodopa and virtual reality-based therapy for rehabilitation of the upper limb after acute stroke: pilot study Part II

<p><b>INTRODUCTION</b>This study aimed to evaluate the safety and efficacy of a combination of levodopa and virtual reality (VR)-based therapy for the enhancement of upper limb recovery following acute stroke.</p><p><b>METHODS</b>This was a pilot single-blinded case series of acute stroke patients with upper extremity hemiparesis. Patients were randomised to standard care with concomitant administration of either levodopa alone (control group) or combination therapy consisting of VR-based motivational visuomotor feedback training with levodopa neuromodulation (VR group). Main clinical outcome measures were the Fugl-Meyer Upper Extremity (FM-UE) assessment and Action Research Arm Test (ARAT). Kinematic measurements of affected upper limb movement were evaluated as a secondary measure of improvement.</p><p><b>RESULTS</b>Of 42 patients screened, four patients were enrolled in each of the two groups. Two patients dropped out from the control group during the trial. Patients receiving combination therapy had clinically significant improvements in FM-UE assessment scores of 16.5 points compared to a 3.0-point improvement among control patients. Similarly, ARAT scores of VR group patients improved by 15.3 points compared to a 10.0-point improvement in the control group. Corresponding improvements were noted in kinematic measures, including hand-path ratio, demonstrating that the quality of upper limb movement improved in the VR group.</p><p><b>CONCLUSION</b>Our results suggest that VR-based therapy and pharmacotherapy may be combined for acute stroke rehabilitation. Bedside acquisition of kinematic measurements allows accurate assessment of the quality of limb movement, offering a sensitive clinical tool for quantifying motor recovery during the rehabilitation process after acute stroke.</p>

The use of virtual reality-based therapy to augment poststroke upper limb recovery

Stroke remains one of the major causes of disability worldwide. This case report illustrates the complementary use of biomechanical and kinematic in-game markers, in addition to standard clinical outcomes, to comprehensively assess and track a patient's disabilities. A 65-year-old patient was admitted for right-sided weakness and clinically diagnosed with acute ischaemic stroke. She participated in a short trial of standard stroke occupational therapy and physiotherapy with additional daily virtual reality (VR)-based therapy. Outcomes were tracked using kinematic data and conventional clinical assessments. Her Functional Independence Measure score improved from 87 to 113 and Fugl-Meyer motor score improved from 56 to 62, denoting clinically significant improvement. Corresponding kinematic analysis revealed improved hand path ratios and a decrease in velocity peaks. Further research is being undertaken to elucidate the optimal type, timing, setting and duration of VR-based therapy, as well as the use of neuropharmacological adjuncts.

Prevalence and Clinical Features of Detrusor Underactivity among Elderly with Lower Urinary Tract Symptoms: A Comparison between Men and Women

PURPOSE: To identify the prevalence and clinical features of detrusor underactivity (DU) in elderly men and women presenting with lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: We reviewed 1,179 patients aged over 65 years who had undergone a urodynamic study for LUTS with no neurological or anatomical conditions. DU was defined as a bladder contractility index <100 and a maximal flow rate (Qmax) < or =12 ml/s combined with a detrusor pressure at Qmax < or =10 cmH2O for men and women, respectively. RESULTS: Of the patients, 40.2% of men and 13.3% of women were classified as having DU (p<0.001). Types of clinical symptoms were not significantly different between patients with and without DU. In men, whereas the prevalence of bladder outlet obstruction (BOO) was constant across the age spectrum, the prevalence of DU and detrusor overactivity (DO) increased with age, and 46.5% of men with DU also had DO or BOO. In women, the prevalence of DU also increased with age, and the trend was more remarkable in women aged over 70 years. DU was accompanied by DO or urodynamic stress urinary incontinence (USUI) in 72.6% of the women with DU. Women with DU were found to have lower cystometric capacity and exhibited a greater incidence of reduced compliance than did women without DU. CONCLUSIONS: DU was a common mechanism underlying LUTS in the elderly population, especially in men. One half of the men and three quarters of the women with DU also had other pathologies such as DO, BOO, or USUI.

Health Literacy ‐ Asking the Right Questions & Broad Concepts

The ability to make informed health decisions is a complex process. Knowing when to consult a healthcare professional, understanding one's medical condition and learning how to take medicines correctly require that health information can be accessed, processed and applied effectively by the individual. These statements underpin the concept of "health literacy" which may be defined as the degree to which people have the ability to find, understand, act and communicate health information to make informed health decisions. To communicate at a level that helps patients to make use of health information, there is a need for the healthcare professional to first be able to identify and understand the patient's health literacy by considering age, gender, cultural background, education level, thoughts and behaviours associated with the topic under discussion, and perceived benefits and barriers towards the topic. Five strategies can then be applied for improving that patient's understanding and self management of his or her medical condition: (1) Assess patients' health literacy using open-ended questions; (2) Speak in plain language; (3) Limit the number of teaching points; (4) Use visual aids, and (5) Incorporate the 'teach-back' method to ensure patient understanding.

Studies on glutamic pyruvic- and oxaloacetic transaminase of different organs of Ascaris lumbricoides suis

A Study on glutamic pyruvic and oxaloacetic transaminase of different organs(e.g intestine, seminal vesicle, reticular tissue, uterus, ovary, testes) in Ascaris lumbricoides suis have been investigated. The activity of transaminase were determined on the whole homogenates and subcellular fractions separated by differential centrifugation. The activity of glutamic pyruvic and oxaloacetic were assayed by colorimetric method of Reitman-Frankel. The results were obtained as follows: About ninty percent of the glutamic pyruvic and oxaloacetic transaminase in different organs was found to be localized in the supernatant fraction with the separation of differential centrifugation. And it was found that ten percent of glutamic pyruvic and oxaloacetic transaminase exists in the mitochondrial fraction. The specific activity of glutamic oxaloacetic transnaminase in different organs was relatively higher than the glutamic pyruvic transaminase activity.