Hemoglobin Concentration May Influence the Incidence of Postoperative Transient Neurological Events in Patients With Moyamoya After Extracranial-intracranial Arterial Bypass: A Retrospective Single Center Experience.

BACKGROUND: Moyamoya is a rare condition characterized by cerebral angiographic findings of intracranial carotid artery stenosis with abnormal net-like vessels in the brain, and often presents as transient ischemic attacks or intracranial hemorrhage. Revascularization in the form of extracranial-intracranial (EC-IC) artery bypass has demonstrated efficacy in preventing ischemic attacks and intracranial hemorrhage, although it is associated with a relatively high rate of perioperative ischemic and hemorrhagic stroke. This retrospective analysis aims to evaluate the possible association between postoperative hemoglobin (Hgb) concentration and early postoperative transient neurological events (TNEs) experienced at our center. METHODS: Consecutive patients undergoing EC-IC bypass between January 1, 2017 and August 31, 2019 were identified, resulting in a study population of 24 patients with 34 individual cases for different cerebral hemispheres. Postoperative Hgb level was evaluated upon arrival to the intensive care unit (ICU) and the primary outcome was the occurrence of TNEs within 24-hours after surgery. RESULTS: The incidence of TNEs within 24 hours postoperatively was 12% (n=4). Statistically significant differences were demonstrated between patients who did and did not experience TNEs in the postoperative period: total Hgb value (mean 9.4 vs. 11.3 g/dL, respectively; P=0.012) and percentage of patients with Hgb <10 g/dL (75% vs. 20%, respectively; P=0.048). Patients with a postoperative Hgb value <10 g/dL upon arrival to the ICU were significantly more likely to experience TNEs (odds ratio, 12; 95% confidence interval, 1.053-136.794; P=0.045). CONCLUSIONS: This study reports a possible association between postoperative Hgb level and the occurrence of TNEs within the first 24 hours after surgery in patients undergoing EC-IC for moyamoya.

Laparoscopic management of benign adnexal mass in obese women.

STUDY OBJECTIVE: To compare complications and rate of conversion to laparotomy between normal-weight, preobese, and obese women who underwent laparoscopic management of benign adnexal mass. DESIGN: Retrospective chart review (Canadian Task Force classification II-3). SETTING: Tertiary care teaching hospital. PATIENTS: One hundred seventy women who underwent laparoscopic surgery because of benign adnexal mass were placed in three groups on the basis of their body mass index (BMI) using the World Health Organization's classification (normal-weight [BMI 18.5-24.9 kg/m2], preobese [BMI 25-29.9 kg/m2], and obese [BMI > or = 30 kg/m2]). INTERVENTION: Retrospective comparison of conversions from laparoscopy to laparotomy, operative time, estimated blood loss, complications, history of pelvic inflammatory disease, endometriosis, and length of hospital stay was carried out among the different groups. MEASUREMENTS AND MAIN RESULTS: Overall, 170 laparoscopic cases were evaluated (64 with normal-weight, 67 preobese, and 39 obese women). The rate of conversion to laparotomy was significantly higher in the obese and preobese groups compared with the normal-weight women (17.9%, 17.9% vs 1.5%, p < .01). Obese women were 13 times more likely to undergo conversion than normal-weight women (OR 13.78; 95% CI 1.76-29.1). In addition, obese women had significantly longer surgeries (143 +/- 87 minutes vs 114 +/- 41 minutes [p = .04]) and longer hospital stay (1.07 +/- 1.83 days vs 0.51 +/- 1.06 days [p = .04]) when compared with normal-weight women. There was no significant difference in history of pelvic inflammatory disease, endometriosis, and adhesions at the time of laparoscopy between obese, preobese, and normal-weight women. The rate of complications was similar among the groups. CONCLUSION: Obese and preobese women undergoing laparoscopic management of benign adnexal mass were found to be at an increased risk for conversion to laparotomy, longer surgery and longer hospital stay. Obese and preobese women should be counseled extensively on morbidity associated with laparoscopy.