Needlescopic appendectomy versus conventional laparoscopic appendectomy in young patients.

INTRODUCTION: Several studies have reported that needlescopic appendectomy (NA) is a safe and effective procedure for appendicitis because of reduced trocar wounds and tissue trauma. The aim of this study was to evaluate the efficacy of NA in young patients under 40 years of age whose cosmesis matters with appendicitis by comparing it to conventional laparoscopic appendectomy (CLA). METHODS: We retrospectively reviewed our database looking for patients under 40 years of age diagnosed with appendicitis who underwent NA or CLA from January 2013 to April 2017. Patients were divided into two groups: the NA group, and the CLA group. Data collected from each group included age, gender, body mass index, preoperative C-reactive protein, emergency or non-emergency settings, operative time, postoperative length of stay, postoperative complications, and pathological diagnosis. RESULTS: Fifty-four patients underwent NA and 53 patients underwent CLA. The groups were similar in terms of demographic features. Pathological diagnoses were divided into the following categories: catarrhalis (n = 35), phlegmonous (n = 37), and gangrenous (n = 35). No significant difference was noted regarding the distribution of the three groups (P = .4). NA resulted in significantly shorter operative times (P = .0005), and reduced lengths of hospital stay (P = .03) as compared to CLA. There was no significant difference in the number of complications between the two groups. CONCLUSION: NA might be an effective surgical technique when performing a laparoscopic appendectomy in young patients with appendicitis.

Discitis due to late-onset mesh infection 14 years after inguinal hernia repair: a case report.

BACKGROUND: Mesh infection after inguinal hernia repair is a very rare complication. The incidence of late-onset mesh infection is approximately 0.1-0.2% of total hernia repair cases and can lead to serious complications if not treated promptly. Here, we report a rare case of discitis due to late-onset mesh infection, occurring 14 years after an inguinal hernia repair. CASE PRESENTATION: An 89-year-old man was brought to our hospital with right-sided abdominal pain and signs of hypoglycemia. He had a history of type 2 diabetes mellitus and had undergone inguinal hernia repair 14 years ago. Upon admission, laboratory tests revealed no elevated inflammatory markers. Computed tomography (CT) revealed a peri-appendicular abscess. Although the patient was administered empiric antibiotics, on day 3 of admission, his white blood cell count and C-reactive protein levels increased to 38,000/µl and 28 mg/dl, respectively. CT-guided drainage was attempted but was not successful. Escherichia coli was detected in both blood culture collections. On day 7 of admission, the patient complained of back pain; CT on day 10 revealed a peri-appendicular abscess with a soft tissue shadow anterior to the thoracic vertebrae at the 8th/9th level. Thoracic discitis, due to bacteremia originating from the mesh abscess, was suspected. We surgically resected the appendix, followed by removal of the plug and mesh abscess. The post-operative course of the patient was uneventful. For treating discitis, it is known that antibiotic therapy is required for a minimum of 6 weeks. Therefore, on the 30th day post-surgery, the patient was transferred to the orthopedic ward for continued treatment. CONCLUSIONS: This report discusses a rare case of late-onset mesh infection leading to thoracic discitis. Since late-onset mesh infection cannot be treated solely with antibiotics, expeditious surgery should be selected when subcutaneous drainage fails. When an immunocompromised patient with bacteremia has a complaint of back pain, purulent spinal discitis should also be suspected.

Detection of circulating tumor DNA in patients of operative colorectal and gastric cancers.

Liquid biopsy is a non-invasive tool to examine the genetic profile of tumors by identification of mutated circulating tumor DNA (ctDNA), which is often analyzed by next generation sequencing (NGS) or droplet digital PCR (ddPCR) assay. We first examined the ctDNA mutation in pre-operative plasma samples obtained from 154 colorectal cancer (CRC) and 46 gastric cancer (GC) patients, using the NGS-based panel assay. The overall detection rate of mutated ctDNA was 72.0% (144 of 200 patients), and the panel-based screening identified 207 and 47 mutations from CRC and GC patients, respectively. The ddPCR analysis was then performed on post-operative samples of 77 patients, and detection of mutated ctDNA was earlier than imaging-based diagnosis in all of 6 patients who showed the tumor recurrences after surgery. Our data also revealed that patients with positive post-operation ctDNA level showed significant shorter recurrence-free survival compared to the patients with negative ctDNA level (HR 14.9; 95% CI, 0.7-313.5; p < 0.0001). These findings suggested that screening of mutated ctDNA by liquid biopsy aids in identifying the patients at high risk of post-operative recurrence, and serial screening of ctDNA would allow to monitor the response after treatment and/or early detection of tumor recurrence.

The expression of pancreatic endocrine markers in centroacinar cells of the normal and regenerating rat pancreas: their possible transformation to endocrine cells.

To determine the progenitor nature of centroacinar cells (CACs), we attempted to compare the expression pattern of endocrine cell markers and PDX-1 (pancreatic duodenal homeobox gene 1) in CACs of both the quiescent and the regenerating rat pancreas. In the normal pancreas, most CACs were relatively small cells with sparse cytoplasm and oval or elongated nuclei. In addition, we noticed a distinct population of a small number of large cells with round nuclei in the centroacinar region. By immunohistochemistry, 0.21% and 0.3% of CACs in normal rat pancreas were respectively found positive for glucagon and insulin, being large CACs and designated as GL-CAC and IL-CAC. They also exhibited the mRNA of each hormone by in situ hybridization (ISH). The ISH signal for glucagon but not insulin was also detected in a subset of small CACs (designated GS-CAC). The expression of PDX-1 was also observed in subsets of small and large CACs (PS-CAC and PL-CAC, respectively). After a 90% pancreatectomy, the relative frequency for GS-CACs, but not those for other CACs, was significantly reduced in two days after surgery. On day 7 after surgery, the number of GS-CACs recovered to preoperative levels, whereas GL-CACs, IL-CACs, PS-CAC, and PL-CAC gradually increased to about double in number. From these results, a portion of CACs was suggested to differentiated into endocrine cells. A possible cell lineage is discussed for endocrine neogenesis during pancreatic regeneration.