Safety and effectiveness of outpatient laparoscopic cholecystectomy in a teaching hospital: a prospective study of 110 consecutive patients

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to evaluate the safety and efficacy of outpatient laparoscopic cholecystectomy (OLC) in a day surgery unit in a teaching hospital. OLC was offered to patients with symptomatic cholelithiasis who met the following established inclusion criteria: ASA (American Society of Anesthesiology) physical status classification class I and II; age: 18 - 70 years; body mass index (BMI) < 30 kg/m²; patient acceptance and cooperation (informed consent); presence of a responsible adult to accompany the patient to his residency; patient residency in Athens. The primary study end-point was to evaluate success rates (patient discharge on the day of surgery), postoperative outcome (complications, re-admissions, morbidity and mortality) and patient satisfaction. A secondary endpoint was to evaluate its safe performance under appropriate supervision by higher surgical trainees (HSTs).</p> <p>Findings</p> <p>110 consecutive patients, predominantly female (71%) and ASA I (89%) with a mean age 40.6 ± 8.1 years underwent an OLC. Surgery was performed by a HST in 90 patients (81.8%). A mean postoperative pain score 3.3 (range 0-6) occurred in the majority of patients and no patient presented postoperative nausea or vomiting. Discharge on the day of surgery occurred in 95 cases (86%), while an overnight admission was required for 15 patients (14%). Re-admission following hospital discharge was necessary for 2 patients (1.8%) on day 2, due to persistent pain in the umbilical trocar site. The overall rate of major (trocar site bleeding) and minor morbidity was 15.5% (17 patients). At 1 week follow-up, 94 patients (85%) were satisfied with their experience undergoing OLC, with no difference between grades of operating surgeons.</p> <p>Conclusions</p> <p>This study confirmed that OLC is clinical effective and can be performed safely in a teaching hospital by supervised HSTs.</p

Postoperative abdominal free air: How much and when is enough? Report of two cases

Postoperative intraperitoneal or ectopic free air may occur after abdominal surgery, gynecologic surgery, laparoscopic surgery, or endoscopic procedures and, in rare cases, represent gastrointestinal perforation, requiring emergency laparotomy. Evaluating patients with postoperative signs of bowel perforation may be difficult, especially when day-case laparoscopic or endoscopic surgery is performed, with the patient readily discharged from hospital. Delayed diagnosis of gastrointestinal perforation due to underestimation of postoperative free air is associated with a high morbidity and mortality rate. We report two cases of patients presenting with postoperative free air along with the clinical presentation and management

Open Lobectomies and Cardiac Biomarkers : vol.17 No1 (2022)

Objective: Troponin is a sensitive biomarker for cardiovascular injury. In lobectomies, perioperative analgesia can be performed with either a combination of thoracic epidural anesthesia and general anesthesia or general anesthesia alone. We wish to demonstrate that patients who receive the former tend to have lower levels of troponin. Method: In this prospective observational study, we included patients who underwent open lobectomy. Cardiovascular markers were recorded postoperatively, in order to correlate the fluctuation of these markers with the application or not of thoracic epidural anesthesia. Results: Forty eight (48) patients were enrolled, 15 (31.3%) received a combination of thoracic epidural anesthesia with general anesthesia, while 33 (68.7%) received general anesthesia alone. Patients with epidural anesthesia were found to have significantly lower levels of troponin 12-24 hours after surgery (8.9±4.1 versus 16.8±10.5, p &lt;0.05), while 48 to 72 hours postoperatively, the troponin values of the two groups did not appear to differ (10.7±6.9 vs. 14.8±8.3, p 0.103). Age, sex and body mass index were not found to be significantly associated with the fluctuation of troponin values in this setting. Conclusion: Patients who undergo open lobectomy receiving a combination of general and thoracic epidural anesthesia appear to maintain lower troponin levels in the immediate postoperative period than patients receiving general anesthesia alone

Artificial Intelligence in Colorectal Cancer Screening, Diagnosis and Treatment. A New Era

The development of artificial intelligence (AI) algorithms has permeated the medical field with great success. The widespread use of AI technology in diagnosing and treating several types of cancer, especially colorectal cancer (CRC), is now attracting substantial attention. CRC, which represents the third most commonly diagnosed malignancy in both men and women, is considered a leading cause of cancer-related deaths globally. Our review herein aims to provide in-depth knowledge and analysis of the AI applications in CRC screening, diagnosis, and treatment based on current literature. We also explore the role of recent advances in AI systems regarding medical diagnosis and therapy, with several promising results. CRC is a highly preventable disease, and AI-assisted techniques in routine screening represent a pivotal step in declining incidence rates of this malignancy. So far, computer-aided detection and characterization systems have been developed to increase the detection rate of adenomas. Furthermore, CRC treatment enters a new era with robotic surgery and novel computer-assisted drug delivery techniques. At the same time, healthcare is rapidly moving toward precision or personalized medicine. Machine learning models have the potential to contribute to individual-based cancer care and transform the future of medicine

Efficacy of intrathecally administered fentanyl versus dexmedetomidine for cesarean section: a double blinded, randomized clinical trial

Background: Dexmedetomidine, a highly selective alpha(2) agonist has been studied in the past for its use as adjuvant to local anesthetics for spinal anesthesia. Fentanyl has also been used as a spinally administered adjuvant to various local anesthetics. The aim of this study was to investigate the duration of motor and sensory block along with the hemodynamic parameters, neonatal Apgar scores, postoperative analgesia and maternal satisfaction of overall anesthetic/analgesic regimen in parturients under ropivacaine 0.75% plus dexmedetomidine or fentanyl spinal anesthesia. Methods: Forty patients American Society Of Anesthesiology (ASA) I or II, scheduled for elective cesarean section were studied. Patients were randomly allocated to receive ropivacaine 0.75% 1.6-2 mL plus 10 mu g fentanyl (Group F, n = 20) or ropivacaine 0.75% 1.6-2 mL plus 10 mu g dexmedetomidine (Group D, n = 20), intrathecally. The primary outcome was duration of motor and sensory block. Secondary outcomes were:neonatal Apgar scores in the first and fifth minute, additional postoperative analgesia, time to first postoperative analgesic dose and maternal satisfaction of overall anesthesia and analgesia. Results: Patients in dexmedetomidine group (Group D) had prolonged duration of motor and sensory block when compared to patients in fentanyl group (Group F). Mean duration of motor block was significantly higher in Group D than in Group F (163.75 min versus 124.75 min respectively, p = 0.013). Regression of the sensory block to T-8 was significantly prolonged for Group D (158.50 min Group D versus 114.25 min in Group F, p = 0.021). Neonatal Apgar scores, additional postoperative analgesia, time to first postoperative analgesic dose and maternal satisfaction of overall anesthesia/analgesia process, did not statistically differ between the groups. Conclusions: Intrathecal dexmedetomidine is associated with prolonged motor and sensory block. Its profile is similar to fentanyl in terms of cardiovascular stability, sedation, Apgar scores, patient satisfaction and postoperative analgesia

Validation of the Patient Neurotoxicity Questionnaire for Patients Suffering From Chemotherapy-Induced Peripheral Neuropathy in Greek

Purpose: The Patient Neurotoxicity Questionnaire (PNQ) represents a diagnostic tool concerning patients with chemotherapy-induced peripheral neuropathy (CIPN). The application of such a tool in the Greek clinical praxis requires validation. Methods: Validation consists of three stages - translation, reverse translation, and patient application. Hundred oncologic patients were assessed by comparing the PNQ to the National Cancer Institute-Common Terminology Criteria for Adverse Events (NCI-CTCAE) at the chemotherapy onset and second, fourth, and sixth sessions. The diagnostic tool’s specific requirements (compliance, validity, concordance, sensitivity, specificity, reliability) were statistically evaluated. Results: Differences between translated texts and between the reverse translation and the original were considered negligible. At the second, fourth, and sixth session compliance was 98%, 95%, and 93% while Cronbach’s a was 0,57 0,69, and 0,81, respectively. Cohen’s weighted. was 0,67 and 0,58, Spearman’s. was 0,7 and 0,98, while the area under the curve (AUC) of the receiver operating characteristic (ROC) was 1 and 0,9 for the sensory and the motor part, respectively. The variance’s linear regression analysis confirmed CIPN worsening over time (P&lt;0.0001). Discussion: The Greek version remains close to the original English version. Compliance rates reflect easy PNQ applications. Cohen’s. values highlight the physicians’ tension to underestimate the patients’ condition. Spearman’s., Cronbach’s a, and AUC values reflect good validity, reliability, and specificity of the PNQ respectively. Finally, the linear analysis confirmed the PNQ sensitivity over time. Conclusions: The PNQ validation in Greek adds a crucial tool to the physicians’ armamentarium. It can now delineate the necessary information to modify the chemotherapy and analgesic treatment regimens at both preventive and acute levels

Pedunculated Focal Nodular Hyperplasia: When in Doubt, Should We Cut It Out?

Focal nodular hyperplasia (FNH) is the second most common benign hepatic tumor and can rarely present as an exophytic solitary mass attached to the liver by a stalk. Most FNH cases are usually detected as incidental findings during surgery, imaging or physical examination and have a high female predominance. However, the pedunculated forms of FNH are particularly rare and commonly associated with severe complications and diagnostic challenges. Hence, our study aims to provide a comprehensive summary of the available data on the pedunculated FNH cases among adults and children. Furthermore, we will highlight the role of different therapeutic options in treating this clinical entity. The use of imaging techniques is considered a significant addition to the diagnostic toolbox. Regarding the optimal treatment strategy, the main indications for surgery were the presence of symptoms, diagnostic uncertainty and increased risk of complications, based on the current literature. Herein, we also propose a management algorithm for patients with suspected FNH lesions. Therefore, a high index of suspicion and awareness of this pathology and its life-threatening complications, as an uncommon etiology of acute abdomen, is of utmost importance in order to achieve better clinical outcomes