Effects of preoperative administration of ginger (Zingiber officinale Roscoe) on postoperative nausea and vomiting after laparoscopic cholecystectomy.

One of the most common postoperative problems is nausea and vomiting. Although using some anesthetic materials has been considered as the mainstay of this phenomenon, the exact factors are not known. Because of several morbidities associated with postoperative nausea and vomiting (PONV), its prevention and treatment has been a challenge for physicians, so several drugs have been recommended for this purpose. Based on the documented antiemetic specificity of ginger, we evaluated and compared the effects of preoperative administration of ginger on PONV with ondansetron administration as the standard medication. The participants included 100 patients with cholelitiasis who were candidate for laparoscopic cholecystectomy. Patients were divided into two groups: group A comprised 50 patients who received 500 mg oral ginger 1 h before surgery, and group B included 50 patients who received 4 mg intravenous ondansetron before completion of surgery. Antiemetic efficacy was assessed by visual analogue scale scores of nausea intensity at 0, 4, 8, 16, and 24 h after surgery and frequency of vomiting during the evaluation period. Although multifactor analysis showed that nausea severity was significantly lower in the ginger group, the data indicated that except 16 h after operation, the differences between two groups in the frequency of vomiting was not significant. In conclusion, though complementary studies are needed to have a strong suggestion, based on this study, we recommend administration of oral ginger 1 h before operation to control the severity of PONV in patients undergoing laparoscopic cholecystectomy.

Low or Ultralow Anterior Resection of Rectal Cancer Without Diverting Stoma: Experience with 28 Patients.

A diverting temporary stoma is frequently used to decrease the chance of anastomosis leakage in the middle and lower rectum cancer surgeries, but its role in preventing the leakage is still doubtful. This study has been designed to evaluate any possible anastomosis complications after a rectum resection and a low or ultralow anastomosis when no diverting stoma is applied in patients with rectal cancer. Twenty-eight patients suffering from rectal cancer were treated by a low anterior resection between the years 2005 and 2008 in Imam Reza University Hospital, Mashhad, Iran. Out of the 28 patients, 6 patients had already undergone a course of neoadjuvant radiotherapy. Anastomosis was performed manually in 23 patients, using a stapler in 5 of them. None of the patients had a diverting stoma. Then, the outcome was evaluated. Fecal incontinence occurred in one of the patients (6.7 %) who had already undergone a course of radiotherapy preoperatively and had a stapler used for anastomosis. No leakage was detected in any of them. The very low incidence of complications in this study, such as those not preventable by a diverting stoma, suggest a very low chance of leakage in low or ultralow anastomosis in patients with rectal cancer and in those who were treated with neoadjuvant radiotherapy.

Concordance between peri-areolar blue dye and peri-incisional radiotracer injections for sentinel node mapping in patients with a history of primary breast cancer excisonal biopsy.

BACKGROUND: We evaluated the concordance between peri-areolar blue dye and peri-incisional radiotracer injections for axillary sentinel node mapping of patients with the history of previous breast lesion excisional biopsy. METHODS: 80 patients with the history of previous excisional biopsy of the breast lesions were included. All patients received two injections of 99mTc-antimony sulfide colloid in both ends of incision line in an intradermal fashion. 2 mL patient blue V dye was injection to all patients in the peri-areolar area of the index quadrant after induction of anesthesia. All blue or hot nodes were harvested as sentinel lymph nodes. RESULTS: At least one sentinel node could be detected during surgery in 79 patients. In total 94 sentinel nodes were detected. All detected sentinel nodes were hot. In three patients sentinel nodes were detected by gamma probe but not blue dye. The tumor location in all of these patients was in the upper lateral quadrant and the incision line was extended into the axillary tail of the breast in all of them. 91 out of 94 sentinel nodes were stained blue, which amounts to 95.8% concordance between blue dye and radiotracer on a per node analysis. CONCLUSIONS: Single peri-areolar injection in the index quadrant would suffice for sentinel node mapping of patients with history of excisional biopsy. Care should be taken in patients with large excisional biopsy in the extreme proximity to axilla.

Reproducibilidad de la linfogammagrafía antes y después de la biopsia excisional de las lesiones primarias de mama: estudio utilizando la inyección periareolar superficial del radiotrazador / Reproducibility of lymphoscintigraphy before and after excisional biopsy of primary breast lesions: A study using superficial peri-areolar injection of the radiotracer

Objetivo. Una cuestión de gran controversia en la biopsia del ganglio centinela de la mama es la aplicabilidad del estudio del ganglio centinela en pacientes con historia previa de biopsia excisional de las lesiones de la mama. En el presente estudio, evaluamos la reproducibilidad de la linfogammagrafía antes y después de la biopsia excisional de las lesiones primarias de mama utilizando la inyección periareolar superficial del radiotrazador. Material y métodos. Se incluyó en el estudio a 18 pacientes programadas para biopsia excisional de lesiones de mama. A las pacientes se les administró una inyección intradérmica del radiotrazador en el área periareolar del cuadrante con tumor, con 1 o 2h antes de la cirugía. La imagen se obtuvo el día posterior a la operación. Inmediatamente tras la primera imagen, a las pacientes se les administró otra inyección del radiotrazador con la misma técnica, dosis y localización. Se realizaron inmediatamente otras series de imágenes de linfogammagrafía, y a las 4h después de la segunda inyección. Se compararon las 2 series de imágenes de linfogammagrafía. Resultados. En 2 pacientes no se pudo identificar el ganglio centinela en ninguna de las series de imágenes. En las 16 pacientes restantes se detectó un ganglio centinela en ambas series de imágenes de linfogammagrafía. Los ganglios centinela de las segundas series de imágenes se detectaron en la misma localización que las primeras series de imágenes, con un contaje al menos 5 veces superior. Conclusiones. La biopsia excisional de las lesiones primarias de mama no parece modificar el patrón del drenaje linfático superficial desde la areola de la mama, pudiendo realizarse el estudio del ganglio centinela tras esta intervención, utilizando la técnica periareolar superficial(AU)

Objective. A major controversial issue in the sentinel node biopsy of the breast is the applicability of sentinel node mapping in patients with the history of previous excisional biopsy of the breast lesions. In the current study, we evaluated the reproducibility of lymphoscintigraphy before and after excisional biopsy of the primary breast lesions using superficial peri-areolar injection of the radiotracer. Material and methods. Eighteen patients scheduled for excisional biopsy of breast lesions were included into the study. The patients received intra-dermal injection of the radiotracer in the peri-areolar area of the index quadrant 1 to 2h before surgery. Imaging was performed the day after surgery. Immediately after completion of the first imaging, the patients received another injection of the radiotracer with the same technique, dose, and location. Other sets of lymphoscintigraphy imaging were taken immediately and 4h post second injection. The two sets of lymphoscintigraphy images were compared. Results. In 2 patients, sentinel node could not be identified in either set of images. In the remaining 16 patients, one sentinel node was detected in both lymphoscintigraphy image sets. The sentinel nodes of the second image sets were all in the same location of the first sets with at least 5 times higher count. Conclusions. Excisional biopsy of the primary breast lesions does not seem to change the superficial lymphatic drainage pattern from the areola of the breast and sentinel node mapping can be performed after this procedure using superficial periareolar technique(AU)

Reproducibility of lymphoscintigraphy before and after excisional biopsy of primary breast lesions: a study using superficial peri-areolar injection of the radiotracer.

OBJECTIVE: A major controversial issue in the sentinel node biopsy of the breast is the applicability of sentinel node mapping in patients with the history of previous excisional biopsy of the breast lesions. In the current study, we evaluated the reproducibility of lymphoscintigraphy before and after excisional biopsy of the primary breast lesions using superficial peri-areolar injection of the radiotracer. MATERIAL AND METHODS: Eighteen patients scheduled for excisional biopsy of breast lesions were included into the study. The patients received intra-dermal injection of the radiotracer in the peri-areolar area of the index quadrant 1 to 2h before surgery. Imaging was performed the day after surgery. Immediately after completion of the first imaging, the patients received another injection of the radiotracer with the same technique, dose, and location. Other sets of lymphoscintigraphy imaging were taken immediately and 4h post second injection. The two sets of lymphoscintigraphy images were compared. RESULTS: In 2 patients, sentinel node could not be identified in either set of images. In the remaining 16 patients, one sentinel node was detected in both lymphoscintigraphy image sets. The sentinel nodes of the second image sets were all in the same location of the first sets with at least 5 times higher count. CONCLUSIONS: Excisional biopsy of the primary breast lesions does not seem to change the superficial lymphatic drainage pattern from the areola of the breast and sentinel node mapping can be performed after this procedure using superficial periareolar technique.

Transient and permanent hypoparathyroidism following thyroidectomy.

AIM: This study was designed to identify the risk factors of transient and permanent hypoparathyroidism in patients undergoing thyroidectomy. We also studied the duration of transient hypoparathyroidism following thyroid surgery. METHODS: A prospective study was conducted on 163 consecutive patients undergoing thyroidectomy. Serum Levels of calcium and parathyroid hormone (PTH) were determined the day before surgery and then on the 1st and 10th postoperative day to determine the postoperative course of serum PTH and calcium. Patients were followed for six months after surgery. RESULTS: The incidence of transient and permanent hypoparathyroidism was 8.6% and 0%, respectively. Among all of variables, only the extent of surgery had a significant relationship with postoperative hypoparathyroidism (P=0.010). PTH measurement at 10th day postoperatively became normal, except in one patient in whom it continued to be low until two months. CONCLUSION: The extent of surgery is the leading cause of postoperative hypoparathyroidism, though, in most of the patients this is a transient complication and PTH level revert to normal within 10 days after surgery.

The role of nasogastric intubation on postoperative gastrointestinal function in patients with obstructive jaundice.

It is the practice of many surgeons to use the routine nasogastric tube after biliary operations, but its usefulness has been questioned. This study was designed to determine the effect of postoperative nasogastric intubation on gastrointestinal function in patients with obstructive jaundice. In this randomized clinical trial, 40 patients who underwent choledochoduodenostomy or hepaticojejunostomy were randomly divided into two groups. Patients in the experimental group did not have the nasogastric tube, and in the control group the nasogastric tube was routinely applied after surgery. Gastrointestinal function was compared in these two groups. Patients with no nasogastric intubation did not show any postoperative complications or prolonged hospital stay. On the contrary, nasogastric tube insertion postponed return of bowel function and increased the incidence of nausea and vomiting, while it did not affect the incidence of postoperative ileus. Routine use of the nasogastric tube after choledochoduodenostomy or hepaticojejunostomy can delay normal gastrointestinal function and increase postoperative discomfort.

Is C-reactive protein helpful for early diagnosis of acute appendicitis?

PURPOSE: Appendectomy is one of the most common surgical procedures all over the world. Although various laboratory tests and imaging studies are available to improve the accuracy of diagnosis, the rate of negative appendectomy is still about 15-30%. This study was designed to assess the diagnostic value of quantitative C-reactive protein (CRP) in patients suspected to acute appendicitis. MATERIALS AND METHODS: In a prospective study, blood samples of 102 patients were collected before appendectomy. CRP was measured by immunoturbidimetry and the data were compared with the final histopathologic reports. Diagnostic accuracy of the CRP test was analyzed by ROC curve. RESULTS: In histopathology, 83 patients (81/4%) had acute appendicitis and 19 (18/6%) had normal appendices. Considering 14 mg/lit as the cut-off point, this test shows 59% (95% CI, 48-69%) sensitivity and 68% (95% CI, 47-88%) specificity. The positive and negative predictive values were 89% (95% CI, 80-97%) and 27% (95% CI, 14-39%), respectively. CONCLUSIONS: The measurement of CRP levels is not an ideal diagnostic tool for ruling out or determination of acute appendicitis.

Prosthetic incisional hernioplasty: clinical experience with 354 cases.

BACKGROUND: The use of prosthetic materials has become the standard of care in the management of incisional hernias because of its association with a low rate of recurrence. In this paper, the results of the treatment of incisional hernias is reported. METHODS: Over a 15-year period, 354 open abdominal wall incisional hernia repairs were performed using the Rives-Stoppa, onlay and inlay techniques. The prosthetic materials used were polypropylene and Mersilene mesh. Using a questionnaire, the individual characteristics, type of operation (technique), type of prosthesis, complications and surgical outcome were recorded and analysed by SPSS software. RESULTS: A total of 354 patients underwent prosthetic incisional hernioplasty, comprising 265 women and 89 men, with a mean age of 52.1 years, using three techniques that included Rives-Stoppa (312), onlay (33) and underlay (9). The majority of complications included seroma (10), infection (8), intestinal fistula (2), mesh removal (2) and respiratory complication (4). Eighty percent of the patients used abdominal belts after the surgical procedure. Recurrent hernias were observed in four patients with a mean of 98 months follow up. All patients received pre-operative intravenous antibiotics and were discharged with oral antibiotics. CONCLUSION: In this series, the prosthetic incisional hernioplasty approaches, especially the Rives-Stoppa method, yielded excellent long-term results, with minimal morbidity in patients and large primary or recurrent incisional repair.

Factors affecting sentinel lymph node detection failure in breast cancer patients using intradermal injection of the tracer

ObjetivoLa biopsia selectiva del ganglio centinela es el método estándar para la estadificación axilar del cáncer de mama. En algunas pacientes el ganglio centinela no es identificado durante la cirugía y tiene que realizarse una linfadenectomía axilar estándar. En este estudio hemos evaluado los factores predictores del fallo en la localización del ganglio centinela utilizando la administración intradérmica del radiotrazador combinada con la inyección de colorante azul de metileno.Material y métodosSe evaluaron retrospectivamente 202 pacientes consecutivas con cáncer de mama, clínicamente estadios I o II. Se analizan y comparan diferentes variables entre las pacientes cuyo ganglio centinela se localizó durante la cirugía y aquellas que no fue posible la detección del ganglio centinela.ResultadosEl ganglio centinela fue identificado en la linfogammagrafía previa en 180 pacientes (89%). El análisis uni y multivariable mostró que la no visualización del ganglio centinela en la linfogammagrafía, la experiencia del cirujano y la existencia de metástasis en los ganglios axilares se asocian con fallo de localización del ganglio centinela durante la cirugíaConclusionesEste estudio muestra la importancia de la linfogammagrafía previa a la cirugía para predecir aquellos pacientes con posible fallo en la localización quirúrgica del ganglio centinela. Recomendamos la necesidad de una fase de aprendizaje de la técnica antes de su aplicación clínica rutinaria(AU)

ObjectiveThe standard method for axillary lymph node staging in early breast cancer is sentinel lymph node biopsy. In some patients the sentinel lymph node can not be localized during surgery and these patients have to undergo standard axillary lymph node dissection. In this study we have evaluated the predictors of sentinel lymph node localization failure using 99mTc-antimony sulfide colloid and intradermal injection combined with blue dye technique.Material and methods202 consecutive patients with early stage breast cancer (clinically stage I or II) were retrospectively evaluated. Patients whose sentinel lymph node was localized during surgery were compared to those with localization failure considering several variables.ResultsSentinel lymph node was successfully located on the pre-operative lymphoscintigraphy images in 180 patients (89%). Both univariate and multivariate analyses showed that only sentinel lymph node non-visualization by pre-operative lymphoscintigraphy, experience of the surgeon, and axillary lymph node involvement are associated with sentinel node localization failure during surgery.ConclusionsThis study shows the importance of pre-operative lymphoscintigraphy in order to identify the group of patients with possible localization failure during surgery and warning the surgeon beforehand. We also recommend that all surgeons pass the learning curve of sentinel lymph node biopsy before routinely performing this procedure(AU)

Factors affecting sentinel lymph node detection failure in breast cancer patients using intradermal injection of the tracer.

OBJECTIVE: The standard method for axillary lymph node staging in early breast cancer is sentinel lymph node biopsy. In some patients the sentinel lymph node can not be localized during surgery and these patients have to undergo standard axillary lymph node dissection. In this study we have evaluated the predictors of sentinel lymph node localization failure using (99m)Tc-antimony sulfide colloid and intradermal injection combined with blue dye technique. MATERIAL AND METHODS: 202 consecutive patients with early stage breast cancer (clinically stage I or II) were retrospectively evaluated. Patients whose sentinel lymph node was localized during surgery were compared to those with localization failure considering several variables. RESULTS: Sentinel lymph node was successfully located on the pre-operative lymphoscintigraphy images in 180 patients (89%). Both univariate and multivariate analyses showed that only sentinel lymph node non-visualization by pre-operative lymphoscintigraphy, experience of the surgeon, and axillary lymph node involvement are associated with sentinel node localization failure during surgery. CONCLUSIONS: This study shows the importance of pre-operative lymphoscintigraphy in order to identify the group of patients with possible localization failure during surgery and warning the surgeon beforehand. We also recommend that all surgeons pass the learning curve of sentinel lymph node biopsy before routinely performing this procedure.

Uncut Roux-en-y esophagojejunostomy: A new reconstruction technique after total gastrectomy.

PURPOSE: Uncut Roux-en-y is a reconstruction method with a main purpose of diminishing Roux stasis syndrome. In this study we performed this procedure to evaluate utility and complications of this technique, as well as its effect on Roux stasis syndrome. METHODS: Total gastrectomy with Uncut Roux-en-y esophagojejunostomy was performed on 94 patients. This technique consists of an artificial jejunal occlusion 5 cm proximal to anastomosis and a jejunojejunostomy between afferent and efferent loops. Diagnosis of "Roux stasis syndrome" was made by clinical criteria. RESULTS: According to the mentioned criteria, the "Roux stasis syndrome" occurred in 21.2% of the patients. Whereas occurrence rate of other complications was: dysphasia (13.8%), benign stricture in anastomosis (9.6%), and fistula (5.3%). CONCLUSIONS: Comparing the results of our study to other related studies indicates that this type of operation has lower rate of "Roux stasis syndrome", and also decreases the postoperative stricture rate of the anastomosis.