Review: Συσχέτιση της συστροφής σιγμοειδούς με ανατομικές παραλλαγές του σιγμοειδούς

Σκοπός: Η μελέτη αυτή αποτελεί μια ανασκόπηση της διεθνούς βιβλιογραφίας που αφορά τις ανατομικές παραμέτρους του σιγμοειδούς κόλου και το κατά πόσο σχετίζονται με συστροφή του σιγμοειδούς, μια σημαντική κλινική κατάσταση που συνδυάζει απόφραξη του κόλου με ταυτόχρονη ισχαιμία αυτού λόγω στραγγαλισμού των αγγείων, η οποία έχει μεγάλη θνητότητα. Η ανασκόπηση αποσκοπεί στην ταυτοποίηση των παραγόντων που οδηγούν σε συστροφή του σιγμοειδούς. Μέθοδος και υλικό: Διενεργήθηκε μια συστηματική ανασκόπηση της Αγγλικής διεθνούς βιβλιογραφίας με χρήση Pubmed και Scopus ως μηχανών αναζήτησης. Οι λέξεις κλειδιά ήταν συστροφή σιγμοειδούς, ισχαιμική κολίτιδα, επιμηκυσμένο σιγμοειδές, ανατομικές παράμετροι σιγμοειδούς. Αποτελέσματα: Έξι μελέτες εκτιμήθηκαν όσον αφορά τις μετρήσεις τους πάνω σε ανατομικές παραμέτρους του σιγμοειδούς, σε ζωντανούς και πτωματικούς πληθυσμούς και κατά πόσο αυτές οι ανατομικές παράμετροι συμβάλλουν στην πρόκληση συστροφής σιγμοειδούς. Επιπλέον, εκτιμήθηκαν επιδημιολογικοί παράγοντες όπως ηλικία, φύλο και εθνικότητα, εάν συμβάλλουν στη συστροφή σιγμοειδούς. Συμπέρασμα: Άτομα με αυξημένο μήκος σιγμοειδούς σε συνδυασμό με αυξημένο ύψος μεσοσιγμοειδούς και στενή βάση αυτού, είναι περισσότερο επιρρεπή σε συστροφή σιγμοειδούς.Background and Aim: The study reviews the literature related to anatomical parameters of the sigmoid colon and their role in sigmoid volvulus formation, a significant clinical condition that may combine colon obstruction and strangulation presence, with a high mortality rate. The review aims to establish the anatomical factors that contribute to the twisting of the sigmoid colon. Materials and Methods: A systematic review of the English language literature was conducted using Pubmed and Scopus databases. The keywords search was "sigmoid volvulus", "anatomical variances of the sigmoid colon", elongated sigmoid colon and "ischaemic colitis". Critical appraisal was performed of included studies using predefined quality assessment lists. Results: Six studies were evaluated concerning the morphometric measurements of sigmoid colon loop and their relation with sigmoid volvulus formation. Moreover, epidemiological parameters like age, gender, ethnicity were examined as well, on how they relate to its other and most importantly with sigmoid volvulus formation. Conclusion: Patients with elongated sigmoid colon, increased height of sigmoid mesocolon and a narrow mesenteric root base, are more susceptible to sigmoid volvulus formation

Mid-term outcomes in the treatment of retroperitoneal sarcomas: a 12-year single-institution experience

Aim To present the experience from collective data regarding patients with retroperitoneal sarcomas that have been operated in and followed up by the University General Hospital of Patras in Rion, Greece, between 2009 and 2020. Methods A retrospective analysis of adult patients treated at our hospital with a diagnosis of primary retroperitoneal sarcoma who underwent tumour resection. Results Data from 29 patients were analysed. The mean age at diagnosis was 56.1 years; 55.2% of patients were male (n=16). Liposarcomas (on histology) were identified in 19 (65.5%) patients, leiomyosarcoma six (20.7%), and other histologic subtypes in four (13.8%) patients. Tumours >5cm were presented in 27 (93.1%) patients. Negative margins were attained in 13 (44.8%) of all patients who underwent surgical resection. Five (17.2%) patients received neoadjuvant radiation, four (13.8%) postoperative radiation, and three (10.3%) patients received both chemotherapy and radiation prior to surgery with the rest of the patients being treated with surgical excision alone. A 3-year follow-up was successful in 21 (72.4%) patients; five (23.8%) patients died. In total, 16 (55.2%) patients were found to have a local recurrence, with no significant difference in patients' age, gender, tumour size, histology, negative surgical margin (Ro) resection, neoadjuvant chemotherapy, or radiation therapy. There was a significant difference in the 3-year survival rate between patients having positive or negative surgical margins (p=0.027). Conclusion The higher 3-year survival rate in patients with retroperitoneal sarcomas when achieving Ro resection warrant further investigation with a larger sample size across different institutions

The role of soluble urokinase plasminogen activator receptor (suPAR) in patients with cancer: a review of the current literature

Aim Several biomarkers are currently used as diagnostic and prognostic tools in patients with cancer. Soluble urokinase plasminogen activator receptor (suPAR) is elevated in acute and chronic inflammatory procedures and several observational studies during the last 20 years have investigated its role in oncology. The purpose of this article was to review the current literature regarding suPAR’s role in clinical practice. Methods A systematic literature search of PubMed, Scopus, OpenGrey and Cochrane Library databases through September 2021 was conducted using the following search terms: “supar”or “soluble urokinase plasminogen receptor” and “cancer” or “malignancy”. Original articles reporting on suPAR’s role in the diagnosis, prognosis and prediction of therapeutic outcomes in patients with confirmed or suspected cancer were included. Results Among 45 found articles, the most were observational cohort studies. The included studies were further categorized by cancer site. SuPAR level was higher in patients with cancer compared to healthy controls, but its diagnostic and prognostic accuracy differs depending on the site of cancer. Conclusion SuPAR has promising aspects in the field of oncology and public health and future research should further investigate its use in clinical practice. As it is elevated in different types of cancer, it could potentially serve as an adjunctive tool for the mass screening of patients with non-specific signs of cancer, but larger cohort studies that support these findings must be conducted

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Expression of claudins-1,4,5,7 and occludin in hepatocellular carcinoma and their relation with classic clinicopathological features and parients survival

SUMMARYBackground. Occludin and claudins are integral constituents of the Tight Junctions (TJs) and are deregulated in various malignancies, including hepatocellular carcinoma (HCC). This study aims to clarify whether claudins 1,4,5,7 and occludin expression profiles may be used as prognostic markers for overall survival and disease-free survival in HCC patients after hepatectomy. Design. The study included 67 hepatectomy specimens obtained from an equal number of patients with HCC who underwent partial hepatectomy in the University Hospital of Patras. Ten normal liver tissues were used as control group. The expression of claudins 1,4,5,7 and occludin in liver biopsies was assessed by immunochemistry. Clinicopathologic features were also determined for each case.Results. Expression of claudins 1,4,5,7 and occludin was significantly increased in HCC specimens in contrast to non-neoplastic liver specimens adjacent to HCC lesions and furthermore, their expression in non-neoplastic liver tissues was significantly higher than in normal controls (p<0.001) Moreover, there was a statistically significant association between low levels of claudin-4 and advanced tumor grade (p=0.03). Down regulated claudin-1 levels were associated with low overall survival in univariate survival analysis (p=0.049) and Kaplan Mayer analysis (p=0.04). Multivariate analysis showed that claudin-4 levels were an independent prognostic factor for survival prognosis (p=0.01). Moreover, downregulated claudin-4 expression was associated with increased recurrence rates and low disease- free survival rates, in univariate analysis (p=0.038), Kaplan Mayer plot (p=0.013) and multivariate analysis (p=0.013). Low levels of claudin-5 and high levels of claudin-7 levels were independent negative prognostic factors according to multivariate analysis (p=0.015 and 0.009 respectively).Conclusions. This study demonstrates that high expression of claudins-1,4,5 and downregulation of claudin-7 are positive prognostic markers associated with good outcome and increased survival rates. Moreover, claudin-4 increased levels may serve as an independent positive prognostic factor for low recurrence rates after hepatectomy.ΠΕΡΙΛΗΨΗΕισαγωγή: Οι κλωντίνες και η αποφραξίνη αποτελούν δομικά συστατικά των πρωτεϊνών διακυτταρικών συνάψεων, οι οποίες αποδιοργανώνονται λειτουργικά σε διάφορα κακοήθη νεοπλάσματα, συμπεριλαμβανομένου και του ηπατοκυτταρικού καρκινώματος (ΗΚΚ). Σκοπός: Στην μελέτη μας, διερευνήσαμε το κατά πόσο είναι εφικτή η κλινική χρήση των κλωντινών- 1,4,5,7 και της αποφραξίνης ως προγνωστικών δεικτών για την ολική επιβίωση και το διάστημα επιβίωσης ελεύθερο νόσου σε ασθενείς με ηπατοκυτταρικό καρκίνωμα μετά από ηπατεκτομή.Μεθοδολογία: Στην μελέτη μας εξετάσαμε 67 βιοψίες ήπατος από 67 ασθενείς με διαγνωσμένο ηπατοκυτταρικό καρκίνωμα που υπεβλήθησαν σε ηπατεκτομή για θεραπευτικούς λόγους στο Πανεπιστημιακό Γενικό Νοσοκομείο Πατρών. Δέκα βιοψίες φυσιολογικού ηπατικού ιστού χρησιμοποιήθηκαν ως μάρτυρες. Η έκφραση των κλωντινών-1,4,5,7 και της αποφραξίνης στους ηπατικούς ιστούς εκτιμήθηκε με τη χρήση ανοσοϊστοχημικής χρώσης. Παράλληλα, εξετάσθηκαν διάφοροι κλινικοπαθολογοανατομικούς παράγοντες για κάθε περιστατικό.Αποτελέσματα: Η έκφραση των κλωντινών-1,4,5,7 και της αποφραξίνης σε παρασκευάσματα ΗΚΚ ήταν αυξημένη σε στατιστικά σημαντικό βαθμό σε σύγκριση με μη νεοπλασματικούς ηπατικούς ιστούς παρακείμενους σε ΗΚΚ καθώς επίσης και σε σύγκριση με φυσιολογικούς ηπατικούς ιστούς (μάρτυρες).( p<0.001 σε κάθε περίπτωση). Επιπρόσθετα, ανευρέθη μια στατιστικά σημαντική συσχέτιση μεταξύ χαμηλών επιπέδων κλωντίνης-4 και χαμηλού βαθμού διαφοροποίησης ΗΚΚ (p=0.03). Τα ελαττωμένα επίπεδα της κλωντίνης-1 βρέθηκαν να σχετίζονται με μειωμένη ολική επιβίωση σε μήνες, στην μονοπαραγοντική cox regression ανάλυση (p=0.049) και στην Kaplan Meier ανάλυση(p=0.04). Η πολυπαραγοντική cox regression ανάλυση έδειξε ότι τα επίπεδα της κλωντίνης-4 αποτελούν ανεξάρτητο παράγοντα που σχετίζεται με την ολική επιβίωση (p=0.01). Eπίσης, τα ελαττωμένα επίπεδα έκφρασης της κλωντίνης-4 σχετίζονται με αυξημένο κίνδυνο υποτροπών και μειωμένο διάστημα επιβίωσης ελεύθερο νόσου στην μνοπαραγοντική ανάλυση (p=0.038), στις καμπύλες Kaplan Meier (p=0.013) και στην πολυπαραγοντική ανάλυση (p=0.013). Τα μειωμένα επίπεδα έκφρασης της κλωντίνης-5 τα αυξημένα επίπεδα έκφρασης της κλωντίνης-7, αποτελούν ανεξάρτητους αρνητικούς προγνωστικούς παράγοντες, σύμφωνα με τα αποτελέσματα της πολυπαραγοντικής ανάλυσης (p=0.015 και 0.009, αντίστοιχα).Συμπέρασμα: Η παρούσα μελέτη αποδεικνύει ότι τα υψηλά επίπεδα κλωντινών- 1,4,5 και τα μειωμένα επίπεδα έκφρασης της κλωντίνης-7 αποτελούν θετικούς προγνωστικούς παράγοντες και σχετίζονται με ευνοϊκή πρόγνωση και αυξημένο διάστημα επιβίωσης. Επιπλέον, τα υψηλά επίπεδα έκφρασης της κλωντίνης-4 μπορεί να χρησιμεύσουν ως ανεξάρτητος θετικός προγνωστικός παράγων για ελαττωμένο κίνδυνο υποτροπών ΗΚΚ μετά από ηπατεκτομή

A Rare Case of Iatrogenic Diaphragm Defect following Laparoscopic Cholecystectomy Presented as Acute Respiratory Distress Syndrome

Laparoscopic cholecystectomy is considered as the gold standard in the treatment of gallbladder disease. Laparoscopy presents significant advantages including decreased hospital stay, better aesthetic results, faster rehabilitation, less pain, reduced cost, and increased patient satisfaction. The complications&apos; prevalence is low; however, the overall serious complication rate seems to be higher compared to open cholecystectomy, despite the increasing experience. Diaphragmatic injury following laparoscopic cholecystectomy is an extremely rare complication, and a high index of clinical suspicion is necessary to diagnose this situation that has a variety of clinical presentations and might be life-threatening. We present a unique case of postlaparoscopic cholecystectomy diaphragm defect with late onset. The clinical findings included those of respiratory distress syndrome along with small bowel incarceration and peritonitis