Minimally invasive colectomies can be performed with similar outcomes to open counterparts for colorectal cancer emergencies: a propensity score matching analysis utilizing ACS-NSQIP.

PURPOSE: The safety and feasibility of minimally invasive surgery (MIS) in the setting of colorectal cancer emergencies have been debated. We sought to compare postoperative outcomes of MIS with open techniques in the setting of colorectal cancer emergencies from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. METHODS: We included patients undergoing colectomy for colorectal cancer emergency between 2012 and 2019 "2012-2019" from the ACS-NSQIP dataset. We compared short-term morbidity, mortality, short-term oncological outcomes, and secondary outcomes for MIS vs open colectomies using propensity score matching. We then evaluated the trends of MIS versus open colectomies using linear regression analysis. RESULTS: We examined a total of 5544 patients (open n = 4070; MIS n = 1474) and included 1352 patients for our postoperative outcome analyses after propensity score matching 1:1 (open n = 676; MIS n = 676). Within the matched cohort, mortality was significantly higher in the open group (open 6.95% vs MIS 3.99%, OR 1.8, p = 0.023). Anastomotic leak rates were comparable between the  two groups (open 4.46% vs MIS 4.02%, OR 1.12, p = 0.787). Pulmonary complications were significantly higher after open surgery (open 10.06% vs MIS 4.73%, OR 2.25, p < 0.001). Rates of ileus were significantly higher amongst open patients (open 29.08% vs MIS 19.94%, p < 0.001). Patients stayed on average 1 day longer in the hospital after open surgery (p < 0.001). Rates of MIS for early tumors (N0 and T1/T2, n = 289) did not significantly change over 7 years (p = 0.597, rate = - 0.065%/year); however, utilization of MIS for late tumors (N1 or T3/T4, n = 4359) increased by 2.06% per year (p < 0.001). CONCLUSIONS: This study demonstrates that MIS was associated with superior postoperative outcomes compared to open surgery without compromising oncological outcomes in patients undergoing emergency colectomy for colon cancer. Within the matched cohort, MIS was associated with lower rates of mortality, pulmonary complications, ileus, and shorter postoperative length of stay.

Effect of saliva decontamination procedures on shear bond strength of a one-step adhesive system.

AIM: To evaluate the effect of different saliva decontamination procedures on the shear bond strength of a one-step universal adhesive system (Single Bond™ Universal Adhesive, 3M ESPE, St. Paul, MN, USA). MATERIALS AND METHODS: The occlusal surfaces of 75 human third molars were ground to expose dentin. The teeth were divided into the following groups: Group 1 (control group): Single Bond™ Universal Adhesive was applied to the prepared tooth according to the manufacturer's recommendations and light cured; no contamination procedure was performed. Group 2: Bonding, light curing, saliva contamination, and dry. Group 3: Bonding, light curing, saliva contamination, rinse, and dry. Group 4: After the procedure performed in Group 2, reapplication of bonding. Group 5: After the procedure performed in Group 3, reapplication of bonding. Then, composite resins were applied with cylindrical-shaped plastic matrixes and light cured. For shear bond testing, a notch-shaped force transducer apparatus was applied to each specimen at the interface between the tooth and composite until failure occurred. The data were statistically analyzed using one-way ANOVA. RESULTS: One-way ANOVA revealed significant differences in shear bond strength between the control group and experimental Groups 2 and 4 (P < 0.05). No significant difference was found for experimental Groups 3 and 5 when compared to the control group (P > 0.05). CONCLUSION: The present in vitro study showed that water rinsing is necessary if cured adhesive resin is contaminated with saliva to ensure adequate bond strength.

Link between angiographic extent and severity of coronary artery disease and degree of sensorineural hearing loss.

AIMS: Atherosclerosis is a systemic disease that can affect the whole arterial tree. An important cause of neuronal degeneration is atherosclerosis, which may lead to sensorineural hearing loss. We aimed to investigate the relationship between the angiographic severity and extent of coronary artery disease, which is a surrogate of atherosclerotic burden, and the degree of sensorineural hearing loss. PATIENTS AND METHODS: Out of 381 consecutive patients who underwent coronary angiography for symptoms suggesting ischemic heart disease and who had ischemia detected by a noninvasive stress test, 265 patients [mean age, 61.5 ± 13.0 years; median age (25th-75th percentile), 59 years (50.5-67)], including 146 male (55.1 %) subjects met the eligibility criteria and were enrolled. Audiological measurements (hearing levels and discrimination scores) were performed before the coronary angiography. The Gensini score was calculated for each angiogram. RESULTS: There was a statistically significant positive correlation between the degree of hearing loss at all frequencies analyzed (250, 500, 1,000, 2,000, 4,000 Hz) and the Gensini score (p < 0.05 for all frequencies), which remained significant after adjustment according to age and other risk factors. A statistically significant negative correlation was observed between the Gensini score and the speech discrimination score (p < 0.05). CONCLUSION: The findings of this study suggest that the angiographic severity and extent of coronary artery disease are significantly and independently correlated with the degree of hearing loss. Sensorineural hearing loss was more prominent in patients with higher Gensini scores. We propose that the findings of this study warrant further research and should be verified in large-scale studies.

Lower levels of serum high-density lipoprotein cholesterol are associated with a worse Duke treadmill score in men but not in women.

BACKGROUND: High-density lipoprotein cholesterol (HDL-C) levels are inversely related to the atherosclerotic burden and are higher in women than in men. We aimed to investigate the sex-specific relationship between serum HDL-C levels and the Duke treadmill score (DTS) in this study. MATERIALS AND METHODS: A total of 111 patients (59 men, 42 women) with suspected coronary artery disease (CAD) who underwent exercise treadmill test (EST) were included. Fasting blood samples were obtained for the assessment of serum lipid levels. DTS was calculated for each patient based on EST findings including ST segment deviation and symptoms. RESULTS: Patients were categorized into a moderate to high risk group based on the DTS score (group-I: 38 patients) and a low risk group (group-II: 63 patients). There was a significant positive correlation between serum HDL-C levels and DTS (r = 0.230; P=0.021). The mean HDL-C level was significantly higher in group-II relative to group-I (49.25 ±11.21 vs. 44.43 ± 11.18, respectively, P = 0.04). An HDL-C level less than the cut-off value of 41.39 mg/dL predicted a moderate to severe risk DTS with 65% sensitivity and 69% specificity in men (area under curve = 0.732, P = 0.004), but not in women (area under curve = 0.505, P = 0.958). After adjustment for traditional CAD risk factors (age, sex, and smoking status), the relationship of DTS to HDL-C remained significant. (P = 0.030; adjusted OR = 0.948 [95% CI, 0.904-0.995]). CONCLUSION: Low HDL-C levels may be associated with a moderate to high risk Duke treadmill score in men, but not in women. Further research is required to clarify the sex-specific relationship between HDL-C and DTS.

The role of bilirubin and its protective function against coronary heart disease.

BACKGROUND: Atherosclerotic cardiovascular disease is the leading cause of morbidity and mortality both in industrialized and developing countries. Atherosclerosis is a chronic inflammatory disease of the arterial wall, which also involves deposition and peroxidation of lipids. Bilirubin, an important endogenous antioxidant, may limit lipid peroxidation and retard the progression of atherosclerosis. Previous studies have reported an inverse relationship between serum bilirubin levels and the risk of coronary artery disease (CAD). Taking into account that atherosclerosis is a complex process that is initiated and accelerated by diverse risk factors, we aimed to test the antiatherosclerotic effects of bilirubin in a population with multiple risk factors for CAD. METHODS: The study included 221 patients who underwent coronary angiography owing to symptoms suggestive of ischemia and/or positive noninvasive stress test results. Of the patients, 76 had normal coronary angiograms and served as the control group. The remaining 145 patients with documented CAD and two or more cardiovascular risk factors constituted the study group. The study group (n=145) was further classified according to the Gensini score as follows: group 1 if Gensini score was 1-19 (minimal CAD, n=82), and group 2 if Gensini score was 20 or higher (significant CAD, n=63). Biochemical assessments including total and direct serum bilirubin levels were carried out using standard methods in automated systems. RESULTS: All of the cardiovascular risk factors were found significantly more frequently in the study group (groups 1 and 2) than in the control group. Total and direct serum bilirubin levels did not differ significantly between the control group, group 1, and group 2. There was a moderate and significant positive correlation between direct bilirubin levels and the Gensini score (r = 0.158, p = 0.019). There was no significant correlation between total bilirubin levels and the Gensini score. CONCLUSION: In conclusion, our findings suggest that in the presence of multiple risk factors, similar concentrations of serum bilirubin may not confer the same level of protection against CAD as in an individual with a more favorable risk profile. The relationship between direct bilirubin levels and the Gensini score is unlikely to be causative, given the established antiatherosclerotic effects of bilirubin.

Extramedullary plasmacytoma of the septum.

PROBLEM: Extramedullary plasmacytoma of the head and neck is a rare neoplasm characterized by monoclonal proliferation of plasma cells. The nasal cavity and nasal septum are the most common sites of occurrence and the neoplasm can be solitary or multiple. Extramedullary plasmacytoma is associated with the initial appearance of multiple myeloma and may precede overt manifestations of systemic disease by months or years. METHODOLOGY: A seventy-year-old female presented to our clinic with a one-month history of nasal obstruction. We performed a systematic approach to diagnosis using clinical, laboratory, and radiologic investigations in order to exclude systemic involvement. RESULTS: The patient was diagnosed with extramedullary plasmacytoma and the mass was excised completely via transnasal endoscopy. CONCLUSION: Extramedullary plasmacytoma of the nasal cavity is rare and should be considered in the differential diagnosis of nasal cavity masses.

Necrotizing lymphadenitis of the neck.

Necrotizing lymphadenitis of the neck. Histiocytic necrotizing lymphadenitis is a rare cause of cervical lymphadenopathy. It is a benign, self-limiting disease whose etiology is unknown. Cervical lymphadenopathy and fever are the most important signs. Here we report a 25-year-old female presenting with complaints of fever and a painless swelling in the neck for three months. An excisional biopsy of a posterior cervical lymph node was performed, and histological evaluation revealed histiocytic necrotizing lymphadenitis. This article discusses our case of histiocytic necrotizing lymphadenitis of the neck as well as the relevant literature.

Bicanalicular silicone tubes versus otologic T-tubes in endonasal dacryocystorhinostomy.

OBJECTIVE: We compared the efficacy of T-tubes and bicanalicular silicone tubes in endonasal dacryocystorhinostomy (DCR). METHOD: We retrospectively reviewed 54 eyes of 49 patients who had experienced nasolacrimal duct obstruction and undergone endoscopic DCR. Group one had bicanalicular silicone tube stents implanted (24 eyes), and group two consisted of patients who had otologic T-tubes (30 eyes). The duration of stent placement, follow-up time, and the subjective and objective success of the procedures were evaluated. Cases were grouped as failure or success according to improvement in epiphora complaint. RESULTS: An endoscopic DCR procedure was successful in 19 (79.2%) cases in the silicone group and in 23 (76.7%) cases in the T-tube group. The success rate did not differ significantly between the groups (p = 0.83). The most common cause of failure was granuloma formation in the bicanalicular silicone tube group and spontaneous tube loss in the otologic T-tube group. CONCLUSIONS: The findings revealed that both the otologic T-tube and the bicanalicular silicone tube had similar success rates (76.7% and 79.2%, respectively). We believe that otologic T-tubes, which are less expensive and more easily acquired, might be offered as an alternative to bicanalicular silicone tubes in patients with nasolacrimal duct obstruction.

A case report of hemangioendothelioma of the hard palate.

Hemangioendothelioma is a rare vascular tumour with potential for malignancy that is intermediate between that of a benign hemangioma and a malignant angiosarcoma. This tumour occurs infrequently in the head and neck regions. In this report, we describe and discuss a case of hemangioendothelioma that originated in the hard palate of a 49-year-old woman.

Quality of life after surgery for benign disease of the parotid gland.

OBJECTIVE: To evaluate quality of life after surgery for benign neoplastic disease of the parotid gland. PATIENTS AND METHODS: A quality of life questionnaire, which was created from the Hebrew version of the University of Washington Quality of Life prototype, was applied to 55 patients who underwent surgery for benign neoplastic parotid disease. All patients were examined in Baskent University Adana Teaching and Medical Research Center, where all except 10 subjects (who responded by phone) completed the quality of life questionnaire. RESULTS: The highest overall score was 96.3 indicating no salivary fistula. Only one patient complained of salivary secretion through the wound scar. The lowest overall score was 59.5 indicating loss of sensation. Although no post-surgical pain was reported by 32 (58 per cent) patients, 16 (29 per cent) patients reported a post-surgical change in their appearance. Scarring and surgical site depression were reported by 26 (47 per cent) and 17 patients (30 per cent), respectively. Facial nerve impairment was reported by seven patients (13 per cent) during the early post-operative period; these patients recovered from that impairment. The only significant statistical correlations were noted between general health and gender, and between post-surgical pain and gender. There was not any statistical correlation between all data and age, tumour type and education level. CONCLUSION: The general status of patients who have undergone surgery for a benign parotid neoplasm can be assessed with a quality of life questionnaire. Patients' post-surgical quality of life can be improved by the correct choice of surgical approach and reconstructive method.

Epidural magnesium reduces postoperative analgesic requirement.

BACKGROUND: Magnesium has antinociceptive effects in animal and human models of pain. Our hypothesis was that the addition of magnesium to postoperative epidural infusion of fentanyl may decrease the need for fentanyl. METHODS: Fifty patients undergoing hip surgery were enrolled to receive either fentanyl (Group F) or fentanyl plus magnesium sulphate (Group FM) for 24 h for epidural analgesia. All patients were equipped with a patient-controlled epidural analgesia device and the initial settings of a demand bolus dose of fentanyl 25 microg. In Group FM, patients received 50 mg magnesium sulphate epidurally as an initial bolus dose followed by a continuous infusion of 100 mg day(-1). Ventilatory frequency, heart rate, blood pressure, pain assessment using a visual analogue scale (VAS), sedation scores and fentanyl consumption were recorded in the postoperative period. RESULTS: There was no significant difference between groups in the time to first analgesic requirement. Compared with Group F, patients in Group FM received smaller doses of epidural fentanyl (P < 0.05). The cumulative fentanyl consumption in 24 h was 437 (SD110) microg in Group F and 328 (121) microg in Group FM (P < 0.05). Patients in Group F showed a higher VAS score in the first hour of the postoperative period (P < 0.05). The groups were similar with respect to haemodynamic and respiratory variables, sedation, pruritus, and nausea. CONCLUSION: Co-administration of magnesium for postoperative epidural analgesia results in a reduction in fentanyl consumption without any side-effects.

Endoscopic removal of a maxillary dentigerous cyst.

Developmental odontogenic cysts account for 10% of all cysts of the jaw. Dentigerous cysts are benign odontogenic cysts. They are associated with the crowns of unerupted teeth. A 24-year-old woman presented with headache, facial pain and facial swelling during the previous six months. Computed tomography revealed a dentigerous cyst in the right maxillary sinus floor. The cyst was removed and the tooth was extracted transnasally with the help of an endoscope. Our case was exceptional because it was seen in a rare area outside the dental area: it was located in the floor of the right maxillary sinus, and it was removed transnasally rather than with one of the more common approaches such as a Caldwell-Luc procedure. This article discusses the dentigerous cyst case, as well as the relevant literature.

[Comparison of patients undergoing functional endoscopic sinus surgery combined with septoplasty or septorhinoplasty]. / Fonksiyonel endoskopik sinüs cerrahisi ile eszamanli septoplasti veya septorinoplasti uygulanan hastalarin karsilastirilmasi

OBJECTIVES: We compared patients who underwent functional endoscopic sinus surgery combined with septoplasty or septorhinoplasty and evaluated the concurrent applicability of septorhinoplasty and endoscopic sinus surgery. PATIENTS AND METHODS: We retrospectively analyzed 145 patients (96 males, 49 females; age range 16 to 78 years) who underwent endoscopic sinus surgery in conjunction with septoplasty or septorhinoplasty. The two patient groups were compared with respect to demographic characteristics, systemic diseases, allergy histories, the presence of nasal polyposis, preoperative paranasal sinus tomographies, Lund-Mackay scores, surgical procedures, operation times, and complication rates. RESULTS: Patients who underwent septorhinoplasty were younger than those undergoing septoplasty. There were no significant differences between the two groups in terms of paranasal sinus tomography scores, allergy histories, systemic diseases, and complication rates (p>0.05). The number of patients with nasal polyposis was significantly greater in the septoplasty group (p<0.05). Septorhinoplasty in conjunction with endoscopic sinus surgery required a significantly longer operation time (p<0.05). CONCLUSION: Complications and the severity of sinus pathologies were similar in the two groups. Concurrent applications of septorhinoplasty and endoscopic sinus surgery significantly increase operation time.

Parotid duct cyst: a case report.

Salivary gland cysts can be benign or malignant. Salivary duct cysts are benign tumours that occur mainly in the parotid gland and represent 10% of all salivary gland cysts. We report the case of a 48-year-old man who presented with a painless preauricular mass on the right side. Superficial parotidectomy was performed based on magnetic resonance imaging (MRI). Histopathologic examination of the specimen revealed a parotid duct cyst. Here we report clinical features, diagnosis, and treatment of the case as well as a review of the literature.

Behcet's disease with a large and free right atrial thrombus.

We present a case of a 27-year-old male patient with Behcet's disease who presented with dyspnoea and haemoptysis in whom further investigation revealed a large and free right atrial thrombus and pulmonary thromboembolism. Considering the absence of haemodynamic compromise and the risk of recurrence after surgical treatment for cardiac thrombus, we preferred medical management which consisted of immunosuppression and anticoagulation. On a follow-up period of 12 months we observed complete dissolution of the thrombus and dramatic improvement of clinical status.

In situ prone ESWL for the treatment of lower ureteral stones: experience with 28 patients.

Twenty-eight patients with lower ureteral stones underwent in situ extracorporeal shock wave lithotripsy (ESWL) in the prone position over the period of 7 months between March 1990 and September 1990. For stone disintegration the spark gap shock wave lithotripter Tripter XI (Direx) was used. Satisfactory disintegration was achieved in 93 per cent of patients. The stone-free rate at 12 weeks was 82 per cent, and 11 per cent had residual fragments less than or equal to 4 mm in diameter. Twenty-one per cent of patients required repeat treatments. For only 2 patients general anaesthesia was required (7 per cent). There were no remarkable complications except for haemospermia which resolved spontaneously 15 days after treatment. It was concluded that in situ prone ESWL is an effective and safe procedure for the treatment of lower ureteral stones.

In situ extracorporeal shock wave lithotripsy for upper ureteral stones: experience with 65 patients.

A total of 65 patients with 67 upper ureteral stones underwent in situ extracorporeal shock wave lithotripsy (ESWL) between March 1990 and September 1990. For stone disintegration the electrohydraulic shock wave lithotripter Tripter XI (Direx) was used. Eighty-seven per cent of stones showed satisfactory disintegration after the first treatment and a further 9 per cent after repeat treatments. The stone-free rate at 12 weeks was 85 per cent. General anaesthesia was needed in only 12 per cent of patients. The retreatment rate was 13 per cent. It was concluded that in situ ESWL is an effective procedure with negligible morbidity for treating upper ureteral stones.

A report on extracorporeal shock wave lithotripsy results on 1,569 renal units in an outpatient clinic.

We report our experience with extracorporeal shock wave lithotripsy (ESWL*) treatment of 1,569 renal units in an outpatient clinic with a small focused piezoelectric lithotriptor. A stone-free rate of 93% was achieved. In 3.6% of the patients, mainly those with a history of surgery and/or anatomical caliceal deformations, fragments smaller than 3 mm. in diameter remained despite multiple ESWL sessions and intensive upside down physiotherapy. Of the cases 3.4%, including those without sufficient data, were considered unsuccessful. We treated 58 renal units in children 14 years old and younger, 55 patients had a single kidney and 7 had a horseshoe kidney.