30-Day postoperative COVID-19 outcomes in 398 patients from regional hospitals utilising a designated COVID-19 minimal surgical site pathway.

INTRODUCTION: Postoperative pulmonary complications and mortality rates during the COVID-19 pandemic have been higher than expected, leading to mass cancellation of elective operating in the UK. To minimise this, the Guy's and St Thomas' Hospital NHS Foundation Trust elective surgery hub and the executive team at London Bridge Hospital (LBH) created an elective operating framework at LBH, a COVID-19 minimal site, in which patients self-isolated for two weeks and proceeded with surgery only following a negative preoperative SARS-CoV-2 polymerase chain reaction swab. The aim was to determine the rates of rates of postoperative COVID-19 infection. METHODS: The collaboration involved three large hospital trusts, covering the geographic area of south-east London. All patients were referred to LBH for elective surgery. Patients were followed up by telephone interview at four weeks postoperatively. RESULTS: Three hundred and ninety-eight patients from 13 surgical specialties were included in the analysis. The median age was 60 (IQR 29-71) years. Sixty-three per cent (252/398) were female. In total, 78.4% of patients had an American Society of Anesthesiologists grade of 1-2 and the average BMI was 27.2 (IQR 23.7-31.8) kg/m2. Some 83.6% (336/402) were 'major' operations. The rate of COVID-19-related death in our cohort was 0.25% (1/398). Overall, there was a 1.26% (5/398) 30-day postoperative all-cause mortality rate. Seven patients (1.76%) reported COVID-19 symptoms, but none attended the emergency department or were readmitted to hospital as a result. CONCLUSION: The risk of contracting COVID-19 in our elective operating framework was very low. We demonstrate that high-volume major surgery is safe, even at the peak of the pandemic, if patients are screened appropriately preoperatively.

Lower serum B12 vitamin concentrations are not accompanied by hyperhomocysteinaemia in chronic spontaneous urticaria.

BACKGROUND: Lower serum vitamin B12 concentrations have been observed in patients with chronic spontaneous urticaria (CSU). It is known that vitamin B12 deficiency is closely related to hyperhomocysteinaemia, which is associated with a proinflammatory state. AIM: To assess the relationship between vitamin B12 status and concentrations of homocysteine (Hcy) with acute phase response in patients with CSU. METHODS: Circulating concentrations of vitamin B12, Hcy and C-reactive protein (CRP) were measured in 42 patients with CSU of varying severity, and compared with 19 healthy controls (HCs). RESULTS: Significantly lower concentrations of vitamin B12 and higher concentrations of CRP were observed in the serum of the patients with CSU compared with HCs (P < 0.01 and P < 0.001, respectively). However, there were no significant differences in plasma Hcy concentrations between the investigated groups. In addition, no correlations were found between the concentrations of vitamin B12, Hcy and CRP. CONCLUSIONS: Lower values of vitamin B12 concentration in patients with CSU were not associated with higher Hcy concentrations, suggesting that such patients do not have functional vitamin B12 deficiency.

Neuroprotective Strategies Can Prevent Permanent Paraplegia in the Majority of Patients Who Develop Spinal Cord Ischaemia After Endovascular Repair of Thoracoabdominal Aortic Aneurysms.

OBJECTIVES: Spinal cord ischaemia (SCI) following endovascular thoracoabdominal aortic aneurysm (TAAA) repair is a devastating and unpredictable complication. This study describes a single unit's experience of SCI in patients who have had endovascular TAAA repair. METHODS: A prospectively maintained database of patients having endovascular TAAA repair using branched and fenestrated stent grafts between 2008 and 2014 at a single high volume centre was reviewed. Patients who developed neurological symptoms and signs related to SCI were identified and factors associated with onset and recovery of neurology were analysed. RESULTS: Sixty-nine patients (median age 73 years, 52 male; Crawford classification type I [n = 4], type II [n = 11], type III [n = 33], type IV [n = 14], type V [n = 7]) underwent endovascular TAAA repair. Twelve patients developed neurological symptoms/signs related to SCI but this was successfully reversed in eight patients, leaving four (5.8%) with permanent paraplegia. The median length of aorta covered was not significantly different in the 12 patients who developed SCI compared with the cohort that did not. Eleven of the patients who developed SCI had an intraoperative mean arterial pressure (MAP) below 80 mmHg. Cutaneous atheroemboli were noted in half of the patients in the SCI group compared with 11% of the non-SCI group (p < .05). Strategies used to reverse SCI included raising MAP, cerebrospinal fluid drainage, angioplasty of stenosed internal iliac arteries, and restoring perfusion to the aneurysm sac. CONCLUSIONS: This series highlights some of the risk factors associated with the development of SCI after endovascular repair of TAAAs. It also illustrates the importance of a dedicated institutional protocol aimed at ensuring the early diagnosis of SCI and prompt intervention to reverse permanent paraplegia in the majority of cases.

SILS (single incision laparoscopic surgery) - new surgical approach to peritoneal cavity.

PURPOSE: The objective of the modern surgery is not only to perform surgical procedures aiming to improve the health condition of the patient, but whenever possible to use minimally invasive approach and to ensure the satisfying cosmetic result. During the last years we can observe an intense development of surgical technique minimizing the access to peritoneal cavity to just one small incision, most frequently localized in the umbilicus. MATERIAL/METHODS: Between October 2009 and May 2010 an overall number of 34 laparoscopic procedures through a single abdominal wall incision were performed at the 2nd Department of Surgery, Jagiellonian University, Medical College in Krakow. There were 28 women and 6 men in the study group ranging in age from 19 - 76 years. Among indications for surgery there were: symptomatic gallbladder stones (21 patients), adrenal gland tumours (8 patients), ITP - Immune Thromocytopenic Purpura (2 patients), appendicitis (2 patients) and splenic cyst (one patient). RESULTS: There were 31 out of 34 procedures completed with pure Single Incision Laparoscopic Surgery (SILS) technique as intended preoperatively without any intraoperative complications. In 3 patients additional trocars were needed for safe continuation of the procedure. There were no intraoperative complications. The mean operating time was 82 minutes ranging from 25 minutes (appendectomy) to 180 minutes (right adrenalectomy). Mean intraoperative blood loss was 0 - 30 ccm. CONCLUSIONS: SILS surgical procedures constitute the next step in the development of minimally invasive surgery. In the hands of experienced surgeon this particular technique may constitute a safe alternative for classical laparoscopy.

Identification and differentiation of Trichophyton rubrum clinical isolates using PCR-RFLP and RAPD methods.

Trichophyton rubrum represents the most frequently isolated causative agent of superficial dermatophyte infections. Several genotyping methods have recently been introduced to improve the delineation between pathogenic fungi at both the species and the strain levels. The purpose of this study was to apply selected DNA fingerprinting methods to the identification and strain discrimination of T. rubrum clinical isolates. Fifty-seven isolates from as many tinea patients were subjected to species identification by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) analysis and strain differentiation using a randomly amplified polymorphic DNA (RAPD) method, with two primers designated 1 and 6. Using PCR-RFLP, 55 of the isolates studied were confirmed to be T. rubrum. Among those, a total of 40 and five distinct profiles were obtained by RAPD with primers 1 and 6, respectively. The combination of profiles from both RAPD assays resulted in 47 genotypes and an overall genotypic diversity rate of 85.4%. A dendrogram analysis performed on the profiles generated by RAPD with primer 1 showed most of the isolates (87.3%) to be genetically related. PCR-RFLP serves as a rapid and reliable method for the identification of T. rubrum species, while the RAPD analysis is rather a disadvantageous tool for T. rubrum strain typing.

Persistence of procoagulant surface expression on activated human platelets: involvement of apoptosis and aminophospholipid translocase activity.

BACKGROUND: Activated platelets express a procoagulant surface when the asymmetric distribution of membrane phospholipids is scrambled, leading to phosphatidylserine (PS) exposure. PS expression, associated with apoptosis in nucleated cells, would be expected to be reversed by aminophospholipid translocase (APLT) activity. OBJECTIVE: To determine whether the procoagulant surface of activated platelets persists after it forms; to examine whether PS expression on platelets is associated with loss of mitochondrial inner membrane potential (DeltaPsi(m)), a hallmark of apoptosis; and to investigate the role of APLT in persistence of PS expression. METHODS: Platelets were stimulated with thrombin, collagen, a combination of both, or the Ca(2+)-ionophore A23187. Up to 4 h after activation, procoagulant surface expression was measured by annexin A5 binding by flow cytometry and by a prothrombinase assay. Flow cytometry was also used to measure PS expression concurrently with DeltaPsi(m) collapse, using CMXRos. APLT activity in annexin A5-negative and -positive platelets was measured flow cytometrically as the percent of 1-palmitoyl-2-[6-[(7-nitro-2-1,3-benzoxadiazol-4-yl)amino]caproyl]-sn-glycero-3-phosphatidylserine (NBD-PS) translocated from the outer to the inner membrane leaflet. RESULTS AND CONCLUSIONS: Procoagulant surface expression on activated platelets persisted in vitro for at least 4 h; if such persistence occurs in vivo, there are important implications for the propagation of thrombosis. With the physiological stimuli, only 10-20% of the activated platelets expressed PS on their surface, and of these, only a portion exhibited DeltaPsi(m) collapse, indicating that PS expression can be associated with platelet apoptosis, but can also occur independently. APLT activity was very low in the PS-expressing platelet subpopulation for up to 4 h after activation, indicating that the persistence of a procoagulant surface may be attributed, at least in part, to this reduced APLT activity.

Treatment of cutaneous T-cell lymphomas with purine analogues (fludarabine and 2-chlorodeoxyadenosine).

PURPOSE: The aim of this study was to evaluate the efficacy and toxicity of the purine analogues 2-chlorodeoxyadenosine (2-CdA) and fludarabine (FAMP) combined with cyclophosphamide (CY) in the treatment of stage III and IV cutaneous T-cell lymphoma (CTCL). PATIENTS AND METHODS: From January 1998 to December 2002, 10 heavily pretreated patients with CTCL, hospitalized at the Department of Dermatology in Wroclaw, were administered monotherapy with 2-CdA (6 patients) or FAMP plus CY combination chemotherapy (4 patients). 2-CdA was administered at a dose of 0.12 mg/kg daily for 7 days every 28 days. FAMP was administered at a dose of 25 mg/m(2) daily, days 1-3, and cyclophosphamide 400 mg/m(2), day 1. The combination was repeated every 28 days. RESULTS: Five out of 6 patients treated with 2-CdA showed a transient partial remission of the skin lesions lasting for a median of 2 months, and 1 patient showed disease progression with dissemination of the skin lesions. Of the 4 patients who received FAMP plus CY 1 achieved complete remission lasting for 6 months, and 2 attained a partial response lasting for a median of 3 months. CONCLUSION: Purine analogues such as 2-CdA and FAMP may be used in the treatment of advanced stages of CTCL. The combination of FAMP plus CY, based on the restrictive effect of FAMP on the repair mechanisms of DNA damaged by CY, seems to be a promising therapeutic modality. Decreased immunity, leucopenia, thrombocytopenia and anaemia are common side effects of 2-CdA and FAMP.

[Appendiceal endometriosis]. / Endometrioza wyrostka robaczkowego.

It was shown in this paper six cases of appendiceal endometriosis identified in 1480 operated patients whom were made an appendectomy in the Obstetric and Gynecology Institute Medical Academy in Lódz during 1977 to 1994. The disease rarely appears and does not show pathognomic symptoms. About 30% cases appeared acute appendicitis symptoms in same author's notes. As a rule it is diagnosed in microscopic examinations of removed appendices. There was also widely discussed foreign medical literature concerning this disease.

[Endometriosis in postoperative abdominal wall scar after cesarean section]. / Endometrioza w bliznach pooperacyjnych powloki brzusznej po cieciach cesarskich.

Endometriosis in postoperative abdominal wall scar after cesarean section is rarely observed. In professional literature, only single cases are reported. The author presented 27 cases of this diseases. The women were treated in the Gynaecology and obstetrics Department of Medical School in Lódz, in 1985-1994. Because of the small response to pharmacological treatment, the treatment of choice was surgical of the lesion. In the article, the literature concerning the disease is presented.

[Ovarian teratomas: some clinical and statistical factors based on 456 patients operated on in the Institute of Gynecology and Obstetrics Academy of Medicine in Lodz]. / Potworniaki jajników: niektóre wspólczynniki kliniczno-statystyczne w oparciu o dane u 456 chorych operowanych w Instytucie Ginekologii i Poloznictwa Akademii Medycznej w Lodzi.

In the years 1977-1994 456 cases of teratomas located in one ovary and 47 in two ovaries were diagnosed. 88,8% of patients were between 16 and 50 years old, with the peak of occurrence between 25 and 30 years. In 5% malignant teratomas were diagnosed.

[Morphological causes of tubal pregnancy]. / Morfologiczne przyczyny jajowodowej ciazy pozamacicznej.

Histological examination was done of 103 fallopian tubes removed surgically due to tubal pregnancy. The examinations were done for finding the causes of abnormal nidation of the fertilized ovum. Sections were taken semiserially. The most frequent change (54.3% of cases) was presence of chronic inflammation with infiltrations composed of lymphocytes and plasma cells, and adhesions between the mucosal folds. Foci of decidual transformation in tubal wall were found in 13.6%, diverticula in 9.7%, and foci of tubal endometriosis in only 2.9% of cases. It is postulated that histological diagnosis should include, besides information on the presence of fertilized ovum, also a description of associated lesions which could be responsible for abnormal nidation.

[Pulmonary edema in a pregnant woman with ureteral calculi complicated by pyelonephritis]. / Obrzek pluc u ciezarnej w przebiegu kamicy moczowodowej powiklanej odmiedniczkowym zapaleniem nerek.

The author presents a case of a 36-year old pregnant woman in 31st week of pregnancy, in whom in the course of renal calculosis complicated by urinary tract infection there appeared pulmonary oedema. Immediate termination of the pregnancy by Cesarean section and applying suitable pharmacological therapy led to the regression of pulmonary oedema, controlling urinary tract infection, and after four weeks--to spontaneous urolith discharge.

[Cytologic picture of smears from the cervix uteri of women using intrauterine contraceptive devices (IUD)]. / Obrazy cytologiczne rozmazów z szyjki macicy kobiet stosujacych wewnatrzmaciczne wkladki antykoncepcyjne (wwa).

PIP: During 1986-87, cervical smears were taken at various phases of menstrual cycles from 63 women aged 25-53 (average age of 34.8 years) wearing IUDs for 3 months to 17 years for the sake of cytological evaluation. 43 patients had Copper T-devices of Finnish make, 8 women had Spider Ws of Polish make, 1 had a Lippes Loop, and 10 had IUDs whose manufacturer could not be verified. The samples were preserved in an alcohol-ether solution, dyed with hematoxylin and eosin, and evaluated according to the 5-degree Papanicolaou scale. The presence of granulocytes indicative of inflammation was ranked: few granulocytes (+), the normal count in healthy women during anovulation wearing no IUDs; an adequate number of granulocytes (++); numerous granulocytes (+++); and a high number of granulocytes (++++). Cytogram II of the Papanicolaou scale was found in 49 women, and cytogram I in 14 women. 5 of 25 women wearing IUDs for 3 years had cytogram I, while 20 had cytogram II. Among 21 patients wearing IUDs for 2 years, there were 4 cases of cytogram I and 17 instances of cytogram II. Women with IUD use of 4-17 years were put into the second group, while all 4 of those with 3 months to 1.5 years of IUD use were listed in the first group. The remaining 6 were sorted into the second group. In 45 (71%) women, varying degrees of inflammation were detected in the presence of neutrophilic granulocytes. In 14 cases (22%) the presence of erythrocytes was demonstrated: few in 7 cases, an adequate number of 4, and an excess number in 3 cases caused either by the IUD or by hormone-induced cervical bleeding. Numerous neutrophilic granulocytes were found in 4 cases and a high number of them in 1 case. The granulocyte count was 10 (+), 17 or 16 (++), 12 (+++), and 6 (++++) indicating moderate or severe inflammation in most preparations. The presence of cytologically suspect or atypical cells was absent in the cervical smears of longterm IUD users. In most women, IUD use was associated with inflammation indicated by the increased number of granulocytes. The persistence of such inflammation may justify the removal of the IUD.^ieng