Short- and long-term outcome after colon cancer resections performed by male and female surgeons: A single-center retrospective cohort study.

BACKGROUND AND OBJECTIVE: To assess the effect of surgeon sex on short- and long-term outcomes after colon cancer resections. METHODS: Clinical data of patients who underwent colon cancer resections between 2010 and 2020 at Helsingborg Hospital, Sweden, were retrospectively obtained from medical records. The sex of the surgeon of each procedure was recorded. Morbidity, mortality, and long-term survival were compared in patients operated by male and female surgeons. RESULTS: Colon cancer resections were performed by 23 male and 9 female surgeons in 1113 patients (79% elective, 21% emergent). After elective surgery, there was no difference in postoperative complications, 30-day mortality, or long-term survival between patients operated by male and female surgeons. Following emergent resections, the complication rate was significantly lower in patients operated by female surgeons (41.3% vs 58.1%, p = 0.019). Similarly, the rates of R1-resections (0% vs 5.2%, p = 0.039), reoperations (3.8% vs 14.2%, p = 0.014), and intensive care unit (ICU) care (6.3% vs 17.4%, p = 0.018) were significantly lower for patients operated by female surgeons, but there was no difference in 30-day mortality (6.3% vs 5.2%, p = 0.767). Cox regression analysis showed that long-term and cancer-free survival in patients emergently operated by male surgeons was significantly shorter than that of patients operated by female surgeons (hazard ratio = 1.9 (95% confidence interval (CI) = 1.3-2.8), p = 0.001 and hazard ratio = 1.7 (95% CI = 1.1-2.7), p = 0.016). CONCLUSIONS: The short- and long-term outcome after elective colon cancer resections were similar in patients operated by male and female surgeons. The outcome following emergent resections performed by female surgeons compared favorably with that of male surgeons, with fewer complications and reoperations and better long-term survival.

Effects of surgical specialization and surgeon resection volume on postoperative complications and mortality rate after emergent colon cancer resection.

BACKGROUND: The aim of this study was to evaluate the effect of surgical specialization and surgeon resection volume on short-term outcome after emergent colon cancer resections. METHODS: A retrospective analysis of all patients who underwent resections for colon cancer between 2011 and 2020 at Helsingborg Hospital, Sweden was performed. The senior surgeon participating in each procedure was classified as a colorectal surgeon or a non-colorectal surgeon. Non-colorectal surgeons were further divided into acute care surgeons or surgeons with other specialties. Surgeons were also divided into three groups based on median yearly resection volumes. Postoperative complications and 30- or 90-day mortality rate after emergent colon cancer resections were compared in patients operated on by surgeons with different specializations and yearly resection volumes. RESULTS: Of 1121 patients resected for colon cancer, 235 (21.0 per cent) had emergent procedures. The complication rate of emergent resections was similar in patients operated on by colorectal surgeons and non-colorectal surgeons (54.1 versus 51.1 per cent respectively), and the subgroup of acute care surgeons (45.8 per cent), whereas resections performed by general surgeons were significantly associated with more frequent complications (odds ratio (OR) 2.5 (95 per cent c.i. 1.1 to 6.1)). The complication rate was numerically highest in patients operated on by surgeons with the highest resection volumes, which differed significantly from that of surgeons with intermediate resection volumes (OR 4.2 (95 per cent c.i. 1.1 to 16.0)). There was no difference in the mortality rate of patients operated on by surgeons with different specializations or yearly resection volumes. CONCLUSION: This study documented similar morbidity and mortality rates after emergent colon resection performed by colorectal and acute care surgeons, but patients operated on by general surgeons had more frequent complications.

Placental weight and birthweight: the relations with number of daily cigarettes and smoking cessation in pregnancy. A population study.

Background: We studied associations of number of daily cigarettes in the first trimester with placental weight and birthweight in women who smoked throughout pregnancy, and in women who stopped smoking after the first trimester. Methods: We included all women with delivery of a singleton in Norway (n = 698 891) during 1999-2014, by using data from the Medical Birth Registry of Norway. We assessed dose-response associations by applying linear regression with restricted cubic splines. Results: In total, 12.6% smoked daily in the first trimester, and 3.7% stopped daily smoking. In women who smoked throughout pregnancy, placental weight and birthweight decreased by number of cigarettes; however, above 11-12 cigarettes we estimated no further decrease (Pnon-linearity < 0.001). Maximum decrease in placental weight in smokers compared with non-smokers was 18.2 g [95% confidence interval (CI): 16.6 to 19.7], and for birthweight the maximum decrease was 261.9 g (95% CI: 256.1 to 267.7). In women who stopped smoking, placental weight was higher than in non-smokers and increased by number of cigarettes to a maximum of 16.2 g (95% CI: 9.9 to 22.6). Birthweight was similar in women who stopped smoking and non-smokers, and we found no change by number of cigarettes (Pnon-linearity < 0.001). Conclusions: In women who smoked throughout pregnancy, placental weight and birthweight decreased non-linearly by number of cigarettes in the first trimester. In women who stopped smoking, placental weight was higher than in non-smokers and increased linearly by number of cigarettes; birthweight was almost similar to that of non-smokers.

Placental weight in the first pregnancy and risk for preeclampsia in the second pregnancy: A population-based study of 186 859 women.

OBJECTIVE: To study whether placental weight in the first pregnancy is associated with preeclampsia in the second pregnancy. STUDY DESIGN: In this population-based study, we included all women with two consecutive singleton pregnancies reported to the Medical Birth Registry of Norway during 1999-2012 (n=186 859). Placental weight in the first pregnancy was calculated as z-scores, and the distribution was divided into five groups of equal size (quintiles). We estimated crude and adjusted odds ratios with 95% confidence intervals for preeclampsia in the second pregnancy according to quintiles of placental weight z-scores in the first pregnancy. The 3rd quintile was used as the reference group. RESULTS: Among women without preeclampsia in the first pregnancy, 1.4% (2507/177 149) developed preeclampsia in the second pregnancy. In these women, the risk for preeclampsia in the second pregnancy was associated with placental weight in the first pregnancy in both lowest (crude odds ratio (cOR) 1.30, 95% confidence interval (CI); 1.14-1.47) and highest quintile (cOR 1.20, 95% CI; 1.06-1.36). The risk associated with the highest quintile of placental weight was confined to term preeclampsia. Among women with preeclampsia in the first pregnancy, 15.7% (1522/9710) developed recurrent preeclampsia, and the risk for recurrent preeclampsia was associated with placental weight in lowest quintile in the first pregnancy (cOR 1.30, 95% CI; 1.10-1.55). Adjustment for interval between pregnancies, maternal diabetes, age, and smoking in the first pregnancy did not alter these estimates notably. CONCLUSION: Placental weight in the first pregnancy might help to identify women who could be at risk for developing preeclampsia in a second pregnancy.

Intrauterine fetal death and risk of shoulder dystocia at delivery.

INTRODUCTION: Vaginal delivery is recommended after intrauterine fetal death. However, little is known about the risk of shoulder dystocia in these deliveries. We studied whether intrauterine fetal death increases the risk of shoulder dystocia at delivery. MATERIAL AND METHODS: In this population-based register study using the Medical Birth Registry of Norway, we included all singleton pregnancies with vaginal delivery of offspring in cephalic presentation in Norway during the period 1967-2012 (n = 2 266 118). Risk of shoulder dystocia was estimated as absolute risk (%) and odds ratio with 95% confidence interval. Adjustment was made for offspring birthweight (in grams). We performed sub-analyses within categories of birthweight (<4000 and ≥4000 g) and in pregnancies with maternal diabetes. RESULTS: Shoulder dystocia occurred in 1.1% of pregnancies with intrauterine fetal death and in 0.8% of pregnancies without intrauterine fetal death (p < 0.0001) (crude odds ratio 1.5, 95% confidence interval 1.2-4.9). After adjustment for birthweight, the odds ratio was 5.9 (95% confidence interval 4.7-7.4). In pregnancies with birthweight ≥4000 g, shoulder dystocia occurred in 14.6% of pregnancies with intrauterine fetal death and in 2.8% of pregnancies without intrauterine fetal death (p < 0.001) (crude odds ratio 5.9, 95% confidence interval 4.5-7.9). In pregnancies with birthweight ≥4000 g and concurrent maternal diabetes, shoulder dystocia occurred in 57.1% of pregnancies with intrauterine fetal death and 9.6% of pregnancies without intrauterine fetal death (p < 0.001) (crude odds ratio 12.6, 95% confidence interval 5.9-26.9). CONCLUSIONS: Intrauterine fetal death increased the risk of shoulder dystocia at delivery, and the absolute risk of shoulder dystocia was particularly high if offspring birthweight was high and the mother had diabetes.

Placental weight in pregnancies with high or low hemoglobin concentrations.

OBJECTIVES: To study the associations of maternal hemoglobin concentrations with placental weight and placental to birthweight ratio. STUDY DESIGN: In this retrospective cohort study, we included all singleton pregnancies during the years 1998-2013 at a large public hospital in Norway (n=57062). We compared mean placental weight and placental to birthweight ratio according to maternal hemoglobin concentrations: <9g/dl, 9-13.5g/dl or >13.5g/dl. The associations of maternal hemoglobin concentrations with placental weight and placental to birthweight ratio were estimated by linear regression analyses, and adjustments were made for gestational age at birth, preeclampsia, parity, maternal age, diabetes, body mass index, smoking, offspring sex and year of birth. RESULTS: In pregnancies with maternal hemoglobin concentrations <9g/dl, mean placental weight was 701.2g (SD 160.6g), followed by 678.1g (SD 150.2g) for hemoglobin concentrations 9-13.5g/dl and 655.5g (SD 147.7g) for hemoglobin concentrations >13.5g/dl (ANOVA, p<0.001). Mean placental to birthweight ratio was highest in pregnancies with maternal hemoglobin concentrations <9g/dl (0.203 (SD 0.036)). We found no difference in mean placental to birthweight ratio for maternal hemoglobin concentrations 9-13.5g/dl (0.193 (SD 0.040)) and >13.5g/dl (0.193 (SD 0.043)). Adjustments for our study factors did not alter the estimates notably. CONCLUSIONS: Placental weight decreased with increasing maternal hemoglobin concentrations. The high placental to birthweight ratio with low maternal hemoglobin concentrations suggests differences in placental growth relative to fetal growth across maternal hemoglobin concentrations.

The influence of age, duration of symptoms and duration of operation on outcome after appendicitis in children.

INTRODUCTION: The aim of the study was to evaluate the impact of any perioperative parameters on the outcome of treatment for appendicitis. MATERIAL AND METHODS: The study included 108 consecutive children with appendicitis. Data were retrieved from files using the codes for appendectomy of the Nordic Classification of Surgical Procedures and the diagnosis codes for appendicitis from the International Classification of Dis-eases (ICD) 10. A non-satisfactory outcome was defined as a post-operative length of stay in hospital ≥ 5 days and/or readmission due to complications. RESULTS: Significantly more patients with a non-satisfactory outcome had complicated appendicitis (73%) compared with those with a satisfactory outcome (25%). A total of 78% of children < 6 years and 44% of children > 10 years had a non-satisfactory outcome. The duration of symptoms before operation was mean 2.8 days for children with a non-satisfactory outcome and 2.7 days for those with complicated appendicitis compared with 1.5 days for children with a satisfactory outcome and 1.6 days for those with simple appendicitis. The median difference was two days in the younger patients. Surgical time was significantly shorter in the group of patients with a satisfactory outcome and in those with simple appendicitis than in the other groups. CONCLUSION: Complicated appendicitis and a non-satisfactory outcome in children after operation are associated with a long preoperative duration of symptoms, young age and long surgical time. A cut-off age has not been established, but young children might benefit from direct referral and access to hospitalization in a regional or tertiary paediatric surgical centre. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

Extreme makeover-OR edition.

With an eye toward becoming a center for orthopedic excellence, one hospital's surgical-services team took the helm of redeveloping the facility's surgical suite.

Risk factors and cofactors for human T-cell lymphotropic virus type 1 (HTLV-1) - associated myelopathy/tropical spastic paraparesis (HAM/TSP) in Jamaica

Human T-cell lymphotrophic virus type 1 (HTLV-1) has been etiologically associated with a neurologic syndrome called HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) as well as with adult T-cell leukemia/lymphoma. The authors sought to quantify the risk in Jamaica of HAM/TSP associated with HTLV-1 infection and cofactors associated with this disease among infected individuals. Between 1988 and 1989, prevalent and incident HAM/TSP patients and controls with other neurologic diseases were enrolled in a retrospective study. A second control group was composed of HTLV-1-seropositive, asymptomatic carriers in Jamaica, ascertained in a separate study conducted in 1988. Although HTLV-1 seropositivity was not a component of the case definition for HAM/TSP, all 43 HAM/TSP patients were HTLV-1 seropsitive compared with two (4.0 percent) of the controls with other neurologic diseases. Given HTLV-1 seropositivity, one cofactor associated with the risk of HAM/TSP was young age at initial heterosexual intercourse (odds ratio = 4.00, 95 percent confidence interval 1.29-12.46 for individuals aged ó15; odds ratio = 4.26, 95 percent confidence interval 1.41-12.90 for individuals aged 16-17 years at initial intercourse). Among individuals who reported this early age at initial sexual intercourse, an increased risk of HAM/TSP was associated with having reported more than five lifetime sexual partners (odds ratio = 2.88, 95 percent confidence interval 0.90-8.70). Neither an early age at initial sexual intercourse nor the number of lifetime sexual partners was a risk factor for adult T-cell leukemia/lymphoma. These data support the hypothesis that HAM/TSP is associated with sexually acquired HTLV-1 infection, whereas adult T-cell leukemia/lymphoma is not. (AU)

Prevalencia de enfermedades de transmisión sexual en las mujeres de Costa Rica / Prevelency of sexually transmitted diseases in CostaRican woman

Pocos estudios han descrito la epidemiología de las infecciones por enfermedades de transmisión sexual (ETS) basándose en muestras serológicas representativas de la población en general y no solo en grupos selectos de pacientes. Ello se debe a la dificultad para obtener serologías en muestras representativas de la población y a la falta de información sobre el historial médico y sexual de los pacientes para quienes existen estudios serológicos. Por otra parte, es solo en años recientes que se ha desarrollado una prueba serológica lo suficientemente específica para diferenciar los anticuerpos a los tipos 1 y 2 del virus del Herpes simplex (VHS) (1) lo que ha hecho posible estimar con precisión la prevalencia de la infección con el VHS de tipo 2 (VHS-2): una de las más importantes ETS. El presente artículo se base en las pruebas serológicas y la información de una muestra nacionalmente representativa de las mujeres de Costa Rica. Describe la prevalencia de anticuerpos al virus del Herpes simplex tipos 1 y 2, sífilis, chlamydia, virus de inmunodefiencia humana (HIV-1) y virus linfotrópico de células humanas-T (HTLV-1) según características demográficas, médicas y sexuales. El artículo también muestra la distribución regional de la prevalencia de anticuerpos a esto agentes