Do you mind the role of spinal sensory block duration in a crucial endocrine disorder of diabetes mellitus? A prospective observational study.

OBJECTIVE: Diabetes mellitus, per se, is a global health concern, which is often accompanied by complications such as diabetic neuropathy. This prospective observational study purposed to assess the durations of spinal sensory block and motor blocks in individuals with and without diabetes mellitus who had undergone spinal anesthesia. METHODS: This study incorporated 80 cases, which were evenly divided into spinal sensory block without diabetes mellitus and spinal sensory block with diabetes mellitus. Various parameters were recorded at different time points, including heart rate, mean arterial blood pressure, SpO2, and spinal block characteristics. Notable measures included maximum spinal sensory block onset time, time to reach the 10th thoracic vertebra (T10), maximal spinal sensory block, time for Bromage scores, and block regression while controlling for age-related variations. RESULTS: Patients in the diabetic group exhibited extended block durations, with significant differences in heart rate noted at specific time points. Regarding the spinal block characteristics, the "maximum onset of SSB" and the "time to reach the T10" were more prolonged in the SSBwDM without significance. Maximum sensory spinal sensory block did not differ. However, some cases in the SSBwDM displayed blocks extending up to the T6. The times to achieve Bromage motor block scores 1-3 were shorter in SSBwDM and lost significance regarding age. Notably, the regression time was longer in SSBwDM, which held significance for both parameters. CONCLUSION: Diabetic cases commonly encounter prolonged block durations post-subarachnoid intervention, potentially linked to nerve sensitivity, age-related changes, and glycemic control. As such, attenuated local doses for diabetic neuropathic cases may enhance early mobilization, attenuate thromboembolic events, and expedite gastrointestinal recovery.

A novel comparison of erector spinae plane block and paravertebral block in laparoscopic cholecystectomy.

OBJECTIVE: Erector spinae plane block is an updated method than paravertebral block, possessing a lower risk of complications. This study aimed to compare erector spinae plane and paravertebral blocks to safely reach the most efficacious analgesia procedure in laparoscopic cholecystectomy cases. METHODS: The study included 90 cases, aged 18-70 years, classified as American Society of Anesthesiologists I-II, who underwent an laparoscopic cholecystectomy procedure. They were randomly separated into three groups, namely, Control, erector spinae plane, and paravertebral block. No block procedure was applied to Control, and a patient-controlled analgesia device was prepared containing tramadol at a 10 mg bolus dose and a 10-min locked period. The pain scores were recorded with a visual analog scale for 24 h postoperatively. RESULTS: The visual analog scale values at 1, 5, 10, 20, and 60 min at rest and 60 min coughing were found to be significantly higher in Control than in paravertebral block. A significant difference was revealed between Control vs. paravertebral block and paravertebral block vs. erector spinae plane in terms of total tramadol consumption (p=0.006). Total tramadol consumption in the first postoperative 24 h was significantly reduced in the paravertebral block compared with the Control and erector spinae plane groups. CONCLUSION: Sonography-guided-paravertebral block provides sufficient postoperative analgesia in laparoscopic cholecystectomy surgery. Erector spinae plane seems to attenuate total tramadol consumption.

Incarcerated obturator hernia, an extremely rare cause of intestinal obstruction: case series.

Protrusion of abdominal contents through the obturator foramen is a rare type of abdominal wall hernia. It is usually seen unilaterally and right-sided. Predisposing factors are old age, high intra-abdominal pressure, pelvic floor dysfunction, and multiparity. Obturator hernia has one of the highest mortality rates of all abdominal wall hernias, with a difficult diagnostic process that can be misleading even for the most experienced surgeons. Therefore, to suspect and easily diagnose an obturator hernia, it is important to understand its characteristics. Computerized tomography scanning remains the best diagnostic tool with the highest sensitivity. Conservative ap-proach is not recommended in obturator hernia cases. Once diagnosed, urgent surgical repair is indicated to prevent further ischemia, necrosis, and risk of perforation that can lead to peritonitis, septic shock, and death. Although open repair is a widely used and effective method for reducing abdominal hernias, including obturator, laparoscopic repairs have been described and become preferred. In this study, we present female patients aged 86, 95, and 90 years who were operated with the diagnosis of obturator hernia on computed tomography. The diagnosis of obturatory hernia should always be kept in mind, especially in the presence of acute mechanical intestinal obstruction findings in an elderly woman.

Preliminary outcomes of five-year survival for ovarian malignancies in profiled Serbian Oncology Centre.

OBJECTIVE: The present study purposed to determine characteristics of ovarian carcinoma and to analyze predictors of survival in patients with ovarian carcinoma. METHOD: A retrospective cohort study was conducted including the patients with diagnosed ovarian carcinoma treated at the Clinic for Operative Oncology, Oncology Institute of Vojvodina in the period from January 2012 to December 2016. Seventy-two women with ovarian carcinoma were included in the analysis. The data about the histological type of tumor, disease stage, treatment, lymphatic infiltration, and surgical procedure were collected retrospectively, using the database of the institution where the research was conducted (BirPis 21 SRC Infonet DOO ‒ Information System Oncology Institute of Vojvodina). Descriptive statistics and multivariate analysis using Cox proportional hazards model were performed. RESULTS: The univariate Cox regression analysis identified histology, tumor grade, FIGO (International Federation of Gynecology and Obstetrics) stage, NACT (Neoadjuvant Chemotherapy), number of therapy cycles, type of surgery, and chemotherapy response as independent predictors of mortality. Finally, the type of tumor and chemotherapy response had an increased hazard ratio for mortality in the multivariate Cox regression model. Herewith, the percentage of high-grade, advanced-stage ovarian cancer patients with complete response to chemotherapy, absence of recurrent disease, and lymphovascular space invasion were significant predictors of survival in patients with ovarian carcinoma. CONCLUSIONS: Herein, emerging data regarding precision medicine and molecular-based personalized treatments are promising and will likely modify the way the authors provide multiple lines of treatments in the near future.

Does enteral nutrition through a percutaneous endoscopic gastrostomy, attenuate Helicobacter pylori colonization?: is it worth mentioning?

OBJECTIVE: In patients who experience difficulties in oral feeding, alimentary intake can be supported by creating direct access into the stomach through a percutaneous endoscopic gastrostomy. The present study purposed to compare naïve and exchanged percutaneous endoscopic gastrostomy tubes in terms of Helicobacter pylori infection and other clinical characteristics. METHODS: A total of 96 cases who underwent naïve or exchanged percutaneous endoscopic gastrostomy procedures with various indications were incorporated into the study. The patients' demographic data, such as age and gender, etiology of percutaneous endoscopic gastrostomy, anti-HBs status, Helicobacter pylori status, the presence of atrophy and intestinal metaplasia, biochemical parameters, and lipid profiles, had been analyzed. In addition, the anti-HCV and anti-HIV statuses had also been evaluated. RESULTS: The most common indication for percutaneous endoscopic gastrostomy placement was dementia in 26 (27.08%) cases (p=0.033). The presence of Helicobacter pylori positivity was significantly lower in the exchange group compared to the naïve group (p=0.022). Total protein, albumin, and lymphocyte levels were significantly higher in the exchange group compared to the naïve group (both p=0.001), and the mean calcium, hemoglobin, and hematocrit levels were statistically significantly higher in the exchange group (p<0.001). CONCLUSION: Preliminary outcomes of the present study revealed that enteral nutrition attenuates the incidence of Helicobacter pylori infection. Considering the acute-phase reactant, the significantly lower ferritin values in the exchange group suggest that there is no active inflammatory process in the patients and that immunity is sufficient.

Does enteral nutrition through a percutaneous endoscopic gastrostomy, attenuate Helicobacter pylori colonization?: is it worth mentioning?

SUMMARY OBJECTIVE: In patients who experience difficulties in oral feeding, alimentary intake can be supported by creating direct access into the stomach through a percutaneous endoscopic gastrostomy. The present study purposed to compare naïve and exchanged percutaneous endoscopic gastrostomy tubes in terms of Helicobacter pylori infection and other clinical characteristics. METHODS: A total of 96 cases who underwent naïve or exchanged percutaneous endoscopic gastrostomy procedures with various indications were incorporated into the study. The patients' demographic data, such as age and gender, etiology of percutaneous endoscopic gastrostomy, anti-HBs status, Helicobacter pylori status, the presence of atrophy and intestinal metaplasia, biochemical parameters, and lipid profiles, had been analyzed. In addition, the anti-HCV and anti-HIV statuses had also been evaluated. RESULTS: The most common indication for percutaneous endoscopic gastrostomy placement was dementia in 26 (27.08%) cases (p=0.033). The presence of Helicobacter pylori positivity was significantly lower in the exchange group compared to the naïve group (p=0.022). Total protein, albumin, and lymphocyte levels were significantly higher in the exchange group compared to the naïve group (both p=0.001), and the mean calcium, hemoglobin, and hematocrit levels were statistically significantly higher in the exchange group (p<0.001). CONCLUSION: Preliminary outcomes of the present study revealed that enteral nutrition attenuates the incidence of Helicobacter pylori infection. Considering the acute-phase reactant, the significantly lower ferritin values in the exchange group suggest that there is no active inflammatory process in the patients and that immunity is sufficient.

Preliminary outcomes of five-year survival for ovarian malignancies in profiled Serbian Oncology Centre

Abstract Objective: The present study purposed to determine characteristics of ovarian carcinoma and to analyze predictors of survival in patients with ovarian carcinoma. Method: A retrospective cohort study was conducted including the patients with diagnosed ovarian carcinoma treated at the Clinic for Operative Oncology, Oncology Institute of Vojvodina in the period from January 2012 to December 2016. Seventy-two women with ovarian carcinoma were included in the analysis. The data about the histological type of tumor, disease stage, treatment, lymphatic infiltration, and surgical procedure were collected retrospectively, using the database of the institution where the research was conducted (BirPis 21 SRC Infonet DOO - Information System Oncology Institute of Vojvodina). Descriptive statistics and multivariate analysis using Cox proportional hazards model were performed. Results: The univariate Cox regression analysis identified histology, tumor grade, FIGO (International Federation of Gynecology and Obstetrics) stage, NACT (Neoadjuvant Chemotherapy), number of therapy cycles, type of surgery, and chemotherapy response as independent predictors of mortality. Finally, the type of tumor and chemotherapy response had an increased hazard ratio for mortality in the multivariate Cox regression model. Herewith, the percentage of high-grade, advanced-stage ovarian cancer patients with complete response to chemotherapy, absence of recurrent disease, and lymphovascular space invasion were significant predictors of survival in patients with ovarian carcinoma. Conclusions: Herein, emerging data regarding precision medicine and molecular-based personalized treatments are promising and will likely modify the way the authors provide multiple lines of treatments in the near future.

Revisiting surgical management of breast cancer in a geriatric population.

OBJECTIVE: Breast cancer is a leading cause of death not only in the young population but also in the elderly. There are no consensus treatment guidelines for elderly breast cancer patients. We purposed to discuss surgical treatment options for breast cancer cases over 80 years concerning morbidity and mortality. METHODS: This retrospective study includes 58 patients over 80 years of age at the time of surgery for breast cancer between 2006 and 2017. A sum of 58 cases (54 females and 4 males), over 80 years of age, with an average age of 84.5±4.07 (80-94) years were included in the study. The modified radical mastectomy was the most common surgical modality in 30 (51.7%) cases, and the axillary intervention was performed on 41 (70.7%). Axillary dissection and sentinel lymph node biopsy were performed for 30 (51.7%) and 11 (18.9%) cases, respectively. RESULTS: Minor and major complications were observed in 8 (13.8%) cases. The average follow-up period of the patients was 37.5 (1-120) months. During the follow-up period, breast cancer-related mortality was observed in 9 (15.52%) cases. No statistical differences were detected in mortality with/without axillary intervention and chosen surgical modality. CONCLUSIONS: Comorbidity, the American Society of Anesthesiologists score, and life expectancy should be considered in the management and surgical planning of patients over 80 years of age with breast cancer. Minimally invasive approaches should be preferred for the elderly whenever feasible and applicable in the light of oncologic surgery principles in order to reduce complications and mortality rates.

Revisiting surgical management of breast cancer in a geriatric population

Abstract OBJECTIVE: Breast cancer is a leading cause of death not only in the young population but also in the elderly. There are no consensus treatment guidelines for elderly breast cancer patients. We purposed to discuss surgical treatment options for breast cancer cases over 80 years concerning morbidity and mortality. METHODS: This retrospective study includes 58 patients over 80 years of age at the time of surgery for breast cancer between 2006 and 2017. A sum of 58 cases (54 females and 4 males), over 80 years of age, with an average age of 84.5±4.07 (80-94) years were included in the study. The modified radical mastectomy was the most common surgical modality in 30 (51.7%) cases, and the axillary intervention was performed on 41 (70.7%). Axillary dissection and sentinel lymph node biopsy were performed for 30 (51.7%) and 11 (18.9%) cases, respectively. RESULTS: Minor and major complications were observed in 8 (13.8%) cases. The average follow-up period of the patients was 37.5 (1-120) months. During the follow-up period, breast cancer-related mortality was observed in 9 (15.52%) cases. No statistical differences were detected in mortality with/without axillary intervention and chosen surgical modality. CONCLUSIONS: Comorbidity, the American Society of Anesthesiologists score, and life expectancy should be considered in the management and surgical planning of patients over 80 years of age with breast cancer. Minimally invasive approaches should be preferred for the elderly whenever feasible and applicable in the light of oncologic surgery principles in order to reduce complications and mortality rates.

Ambulatory Laparoscopic Appendectomy: Does the Conventional Approach Need a Reappraisal?

A Deucalione, acute abdomen remains significant in abdominal pain. The entity of acute abdomen accounts for up to 10% of all emergency admissions. The differences between countries' income and level of prosperity are pertinent, particularly in terms of severity, radiological modalities, and surgical management of the condition. Of note, surgical modalities have been the most widely used treatment modality, and current evidence indicates that the laparoscopic approach, per se, is the most effective surgical therapy with a lower incidence of wound infection, post-intervention morbidity, shorter hospital stay, and better quality of life scores compared to the conventional method. In light of this, the present study aimed to evaluate ambulatory appendectomy in a series of sequential laparoscopic appendectomies (LApp), which included both complicated and uncomplicated cases.

Management of appendicitis in coronavirus disease 2019, severe acute respiratory syndrome coronavirus 2, pandemic era: decreasing incidence with increasing complicated cases?

OBJECTIVE: This study aimed to examine the impact of the coronavirus disease 2019 (COVID-19) pandemic on appendicitis and the relevant outcomes in a tertiary hospital, designated as a "pandemic institution" by the Ministry of Health, between pre-COVID-19 and post-COVID-19, i.e., between 2019 and 2020, of the identical period in terms of the annual schedule. METHODS: The data of cases with acute appendicitis, who were followed up at the Department of General Surgery, a 400-bed, tertiary care, a university-affiliated education and research hospital, providing health care to a population of approximately 450,000 people, during the novel coronavirus SARS-CoV-2, during the identical time intervals of pre-COVID-19 (March 12, 2020 to November 12, 2020) and post-COVID-19 (March 12, 2019 to November 12, 2019), were retrospectively analyzed in a detail. RESULTS: Of the 212 appendectomy operations in total, 99 (46.7%) were performed in the pre-COVID-19 and 113 (53.3%) were performed in post-COVID-19. Compared to the pre-pandemic period, patients who had undergone appendectomies in post-COVID-19 revealed significantly lower neutrophil counts and significantly greater appendix diameters (p<0.001 for both). A significantly lower (p=0.041) acute appendicitis with abundant gangrenous appendicitis and phlegmonous appendicitis (p=0.043 and p=0.032, respectively) was recognized in post-COVID-19 compared with pre-COVID-19 interval. CONCLUSION: The number of appendectomy operations decreased in the COVID-19 pandemic. Patients operated during the pandemic period had wider appendix diameter and lower neutrophil levels. The pathological diagnosis was less frequent acute appendicitis, more frequent gangrenous appendicitis, and phlegmonous appendicitis in the pandemic period.

Management of appendicitis in coronavirus disease 2019, severe acute respiratory syndrome coronavirus 2, pandemic era: decreasing incidence with increasing complicated cases?

SUMMARY OBJECTIVE: This study aimed to examine the impact of the coronavirus disease 2019 (COVID-19) pandemic on appendicitis and the relevant outcomes in a tertiary hospital, designated as a "pandemic institution" by the Ministry of Health, between pre-COVID-19 and post-COVID-19, i.e., between 2019 and 2020, of the identical period in terms of the annual schedule. METHODS: The data of cases with acute appendicitis, who were followed up at the Department of General Surgery, a 400-bed, tertiary care, a university-affiliated education and research hospital, providing health care to a population of approximately 450,000 people, during the novel coronavirus SARS-CoV-2, during the identical time intervals of pre-COVID-19 (March 12, 2020 to November 12, 2020) and post-COVID-19 (March 12, 2019 to November 12, 2019), were retrospectively analyzed in a detail. RESULTS: Of the 212 appendectomy operations in total, 99 (46.7%) were performed in the pre-COVID-19 and 113 (53.3%) were performed in post-COVID-19. Compared to the pre-pandemic period, patients who had undergone appendectomies in post-COVID-19 revealed significantly lower neutrophil counts and significantly greater appendix diameters (p<0.001 for both). A significantly lower (p=0.041) acute appendicitis with abundant gangrenous appendicitis and phlegmonous appendicitis (p=0.043 and p=0.032, respectively) was recognized in post-COVID-19 compared with pre-COVID-19 interval. CONCLUSION: The number of appendectomy operations decreased in the COVID-19 pandemic. Patients operated during the pandemic period had wider appendix diameter and lower neutrophil levels. The pathological diagnosis was less frequent acute appendicitis, more frequent gangrenous appendicitis, and phlegmonous appendicitis in the pandemic period.

Analysis of patients with emergency surgery in a pandemic hospital.

AIM: This study aimed at comparing the patients that received emergency management surgery (surgery and medical treatment) in our hospital, which is a pandemic hospital and provides emergency surgery, with the pre-pandemic period. MATERIAL AND METHODS: Data of the patients who received treatment at the emergency surgery clinic of our hospital between March 12 and May 12, 2020, were compared with those of the patients treated between March 12 and May 12, 2019. RESULTS: A 55% decrease was observed in the number of patients hospitalized in the emergency surgery clinic. There was a 37% decrease in the number of patients with medical treatment, a 63% decrease in the number of the operated patients, and a 60% decrease in the number of patients hospitalized due to trauma. CONCLUSION: Patients requiring urgent surgical treatment hesitate to apply to the pandemic hospital. Histopathologically, delayed surgery might be concerned with significantly more-inflammatory alterations which may lead to irreversible histopathologic and cytostructural changes in the era of emergency surgery. Therefore, we assume that it would be more useful to follow up and treat COVID-19 suspected and positive patients in the pandemic hospitals and to provide the emergency branch service in other hospitals in case of a possible second wave. KEY WORDS: COVID-19, SARS-CoV-2, Pandemic, Trauma, Emergency surgery, Emergency.

Association of Serum C-Reactive Protein Level and Treatment Duration in Acute Cholecystitis Patients Treated Conservatively.

BACKGROUND: Acute cholecystitis (AC) is one of the most common gastrointestinal diseases that require hospitalization and surgical treatment. The treatment of the disease depends upon the severity of the disease and the patients' medical status. OBJECTIVE: In this study, we aimed to investigate if there is an association between the serum C-reactive protein (CRP) value and treatment response and the duration and length of hospital stay in AC patients who are treated conservatively. METHODOLOGY: The medical records of all patients with the diagnosis of AC who were treated with conservative management were included in the study. The demographic and laboratory data including CRP level at first admission to hospital, length of hospital stay, and complications during the conservative treatment were obtained from the patients' records. Patients were divided into two groups according to the treatment response and length of hospital stay. Group 1 patients were defined as patients who responded to the medical treatment in less than three days, and Group 2 patients were defined as patients who did not respond to the medical treatment in three days and stayed at the hospital for more than three days. RESULTS: We identified 101 patients with AC treated medically. Mean age (51.3 ± 16.3, 59.5 ± 15.7; p = 0.013), total leukocyte count (11.8 ± 4.4, 8.2 ± 2.8; p = 0.0005), and CRP value (19.3 ± 13.9, 9.6 ± 5.2; p = 0.0003) were higher in Group 2 compared to Group 1. Correlation analyses demonstrated a significant positive association between the length of hospital stay, total leukocyte count (r = 0.35; p = 0.0002), and CRP value (r = 0.59; p = 0.0004). CONCLUSION: We found that CRP level is associated with treatment duration and hospital stay in AC patients. However, large-scale, prospective further studies are needed to confirm our results and to determine whether CRP levels can be used to discriminate which patient would benefit from medical treatment.

Three-year outcome after anterior component separation repair of giant ventral hernias: A retrospective analysis of the original technique without mesh.

INTRODUCTION: In this study we presented our results with anterior component separation technique utilized in the repair of giant ventral hernias. Our primary endpoints were the rates of surgical site occurrences and recurrence at three years. Besides we investigated the impact of components separation repair on abdominal wall functions. METHODS: We retrospectively analyzed the prospectively-collected data of 40 patients that were operated on between April 2004 and February 2012 for their median ventral hernias sizing larger than 15 cm in width. Our inclusion criteria for component separation program excellently corresponded today's "giant ventral hernia" standards. The method used for components separation was identical to the original Ramirez technique, and did not comprise of any mesh reinforcement. The ICU stays, prolonged intubation, early and late complications, mortality and recurrences at three years were recorded. We used a curl-up test to demonstrate the amelioration of the abdominal wall functions postoperatively. RESULTS: The older age and larger defect size were the significant risk factors necessitating prolonged intensive care. Surgical site occurrences were recorded in 18 patients (45.0%). A total of 7 recurrences (17.5%) were detected at three years. Patients showed a significant improvement in raising their trunks after repair (p < 0.001). CONCLUSIONS: Our findings demonstrated that components separation technique in the original form caused excessive wound complications including skin necrosis which in turn caused delayed discharge from the hospital. The 17.5% recurrence rate seemed higher than those of more recent papers. The already-established newer modifications should be integrated in the repair method. The components separation repair clearly improves abdominal wall functions.

An intraoperative serum parathormone level study in patients with chronic renal failure that underwent subtotal parathyroidectomy What extent of decrease is sufficient at which moment?

AIM: The aim of this study is to determine when to perform intraoperative parathormone (ioPTH) measurement and what extent of decrease in intraoperative serum PTH concentrations indicate success in the operations performed on patients with SHPT associated with chronic renal failure. MATERIAL AND METHODS: 50 consecutive patients who underwent subtotal parathyroidectomy between January 2012 and January 2019 were retrospectively included in this study. Patients were grouped according to persistent hyper parathyroidism (Group1, n:6) and curative surgery (Group 2, n:44). Preoperative serum PTH, calcium, phosphorus and ALP concentrations, intraoperative serum PTH concentrations; and serum PTH, calcium, phosphorus and ALP concentrations of 24th hour after surgery were included to the study. Intraoperatively, 20 minutes after parathyroid gland removal, blood was drawn for PTH assay. The changes in PTH levels between preoperative and intraoperative serum samples were calculated in percentage (ioPTH%) and postoperative 6th month serum PTH and ALP concentrations were included in the study. RESULTS: No significant differences were found by gender, BMI, elapsed period of dialysis treatment and preoperative laboratory values between Group 1 and Group 2. The meanage of Group 1 was 35 years which is lower than Group 2. With the second group, the mean decrease in PTH levels between intraoperative and preoperative serum samples (ioPTH%) was about 90%, which was higher than Group 1. CONCLUSIONS: In conclusion, we believe that, to encounter fewer persistent SHPT cases, it is essential that surgeons monitor ioPTH concentration 20 minutes after gland removal and confirm a decrease of 90% or more in ioPTH concentration. And we should not forget that young patients may tend to develop persistent SHPT. KEY WORDS: Chronic renal failure, Intraoperative parathormone, Secondary hyperparathyroidism, Parathyroidectomy, Subtotal patathyroidectomy.