Systemic inflammatory factors comparison in laparoscopic and open colectomies

Studies dealing with laparoscopic colectomy for cancer have reached to conflicting results in regards to various inflammatory cytokines. Most of them have not examined potential differences with the "open" procedures at later postoperative days, when the immunologic advantage of laparoscopic surgery would be more demanding to be demonstrated (earlier administration of adjuvant treatment). The aim was to detect differences of proinflammatory cytokines between conventional and laparoscopic colectomy for cancer. In this study 30 patients who underwent laparoscopic colectomy were age, sex and preoperative stage-matched with 30 patients treated by "open" surgery. CRP, IL -1, -6, - 8 and IFN-γ serum levels were measured preoperatively, at 24 hours after the operation and at the 7th postoperative day. The results of this study showed that CRP and IL-6 postop values (24 h and 7th POD) were significantly higher than baseline at both groups (p=0.001), but the respective values at the 7th POD were less than at 24 h (p=0.001). IL-1 and -8 levels did not show any differences between assessment timepoints. A higher IFN-y measurement was demonstrated at 24 h compared to baseline at the laparoscopic group only (p=0.03). This difference was not maintained at the 7th POD. IFN-y levels at 24 h and the 7th POD were significantly less at the "open" compared to the laparoscopic group of patients (p=0.001). No correlation was revealed between the measured serum values and age, sex, tumor location and stage. This matched case-control study verifies the already reported lack of differences regarding the IL-1. Controversy still exists on likely IL-6 differences. The inadequately studied IL-8 does not seem to play an important role on immunologic differences. The immunologically beneficial IFN-y, produced by the principal effectors of cell- mediated immunity TH1 cells, seems to have a more active presence following the laparoscopic colectomies potentially contributing to an immunologic "advantage" by counteracting "harmful" cytokines, such as IL-1.Στην παρούσα διδακτορική διατριβή έγινε προσπάθεια να συγκριθεί η φλεγμονώδης αντίδραση που εγείρεται μετά από την ανοικτή και τη λαπαροσκοπική εκτομή τμήματος του παχέος εντέρου λόγω αδενοκαρκινώματος σε κάποιο τμήμα του. Οι ασθενείς χωρίστηκαν σε δύο ομάδες ανάλογα με τον τρόπο που έγινε η επέμβαση και έγινε εξομοίωση στους ασθενείς της μιας ομάδας με τους ασθενείς της άλλης με βάση την ηλικία, το φύλο και το προεγχειρητικό στάδιο. Προεγχειρητικά αλλά και μετεγχειρητικά στην 1η και στην 7η ημέρα πραγματοποιήθηκε αιμοληψία με στόχο την μέτρηση της συγκεντρώσεως διαφόρων κυτοκινών στον ορό των ασθενών. Οι παράγοντες που μετρήθηκαν ήταν οι ιντερλευκίνες 1, 6,και 8, η CRP και η ιντερφερόνη γ. Καμμία διαφορά μεταξύ των δύο μεθόδων δεν αναδείχθηκε για τις ιντερλευκίνες αλλά και την C αντιδρώσα πρωτεΐνη. Διαφορά όμως σε στατιστικά σημαντικό βαθμό ανευρέθει στην ιντερφερόνη γ όπου στην ομάδα της λαπαροσκοπικής χειρουργικής ήταν υψηλότερη η συγκέντρωση στον ορό και στις δύο χρονικές στιγμές σε σχέση με την ομάδα της ανοικτής μεθόδου. Τα αποτελέσματα αυτής της μελέτης δεικνύουν μια καλύτερη διατήρηση της κυτταρικής ανοσίας τόσο άμεσα μετά το χειρουργείο τις πρώτες μετεγχειρητικές ώρες αλλά και απώτερα στην εβδομάδα μετά το χειρουργείο. Η μεγαλύτερη διατήρηση της κυτταρικής ανοσίας από τις λαπαροσκοπικές μεθόδους σε σχέση με τις αντίστοιχες ανοικτές στη χειρουργική του παχέος εντέρου μπορεί να εξηγήσει τη μικρότερη επίπτωση γενικά των σηπτικών επιπλοκών μετά από τη λαπαροσκοπική κολεκτομή αλλά και τα υπόλοιπα τεκμηριωμένα πλεονεκτήματα των ελάχιστα επεμβατικών μεθόδων σε μια τόσο απαιτητική και πολύπλοκη επέμβαση

Papilloma Formation in Esophagus after Covered Metal Stent Placement: Two Case Reports

Aims: To highlight an uncommon situation during stenting for obesity surgery complications. Place and Duration of Study: 1st Propaideutic Surgical Unit, Hippokration Hospital, Athens between December 2008 and November 2010. Results: 2 cases of obese patients are presented where the placing of metal stents in esophagogastric region after leakage in the postoperative period of sleeve gastrectomy, resulted in formation of papilloma at the edge of these stents. Conclusion: May be these cases are two of the very few reports in the medical literature which describe mucosal hyperplasia in the esophagus at the edge of a covered metal stent placed for a benign condition

Gastrointestinal stromal tumor causing small bowel intussusception in a patient with Crohn’s disease

We report a case of jejunoileal intussusception in a 42-year-old patient with Crohn’s disease caused by a gastrointestinal stromal tumor. The patient complained of vague diffuse abdominal pain for a period of 4 mo. Intussusception was suspected at computer tomography and magnetic resonance imaging scans. Segmental resection of the small intestine was performed. Pathological examination of the surgical specimen revealed a gastrointestinal stromal tumor as well as aphthous ulcerations and areas of inflammation, which were characteristic of Crohn’s disease. This is the first report of small bowel intussusception due to a gastrointestinal stromal tumor coexisting with Crohn’s disease

Carpal Tunnel Syndrome Automated Diagnosis: A Motor vs. Sensory Nerve Conduction-Based Approach

The objective of this study was to evaluate the effectiveness of machine learning classification techniques applied to nerve conduction studies (NCS) of motor and sensory signals for the automatic diagnosis of carpal tunnel syndrome (CTS). Two methodologies were tested. In the first methodology, motor signals recorded from the patients’ median nerve were transformed into time-frequency spectrograms using the short-time Fourier transform (STFT). These spectrograms were then used as input to a deep two-dimensional convolutional neural network (CONV2D) for classification into two categories: patients and controls. In the second methodology, sensory signals from the patients’ median and ulnar nerves were subjected to multilevel wavelet decomposition (MWD), and statistical and non-statistical features were extracted from the decomposed signals. These features were utilized to train and test classifiers. The classification target was set to three categories: normal subjects (controls), patients with mild CTS, and patients with moderate to severe CTS based on conventional electrodiagnosis results. The results of the classification analysis demonstrated that both methodologies surpassed previous attempts at automatic CTS diagnosis. The classification models utilizing the motor signals transformed into time-frequency spectrograms exhibited excellent performance, with average accuracy of 94%. Similarly, the classifiers based on the sensory signals and the extracted features from multilevel wavelet decomposition showed significant accuracy in distinguishing between controls, patients with mild CTS, and patients with moderate to severe CTS, with accuracy of 97.1%. The findings highlight the efficacy of incorporating machine learning algorithms into the diagnostic processes of NCS, providing a valuable tool for clinicians in the diagnosis and management of neuropathies such as CTS

Systemic inflammatory response after laparoscopic and conventional colectomy for cancer: a matched case-control study

Studies dealing with laparoscopic colectomy for cancer have reached conflicting results in regards to various inflammatory cytokines. Most of them have not examined potential differences with the open procedures at later postoperative days, when the immunologic advantage of laparoscopic surgery would be more demanding to demonstrate (for earlier administration of adjuvant treatment). The aim of this work is to detect differences of proinflammatory cytokines between conventional and laparoscopic colectomy for cancer. 30 patients who underwent laparoscopic colectomy were age, sex, and preoperative stage-matched with 30 patients treated by open surgery. C-reactive protein (CRP), interleukin (IL)-1, -6, and -8, and interferon (IFN)-gamma serum levels were measured preoperatively, at 24 h, and at the 7th postoperative day (POD). CRP and IL-6 postoperative values (24 h and 7th POD) were significantly higher than baseline for both groups (p = 0.001), but the respective values at the 7th POD were less than at 24 h (p = 0.001). IL-1 and -8 levels did not show any differences between assessment timepoints. A higher IFN-gamma measurement was demonstrated at 24 h compared with baseline for the laparoscopic group only (p = 0.03). This difference was not maintained at the 7th POD. IFN-gamma levels at 24 h and the 7th POD were significantly less for the open compared with the laparoscopic group of patients (p = 0.001). No correlation was revealed between measured serum values and age, sex, tumor location, or stage. This matched case-control study verifies the already reported lack of differences regarding IL-1. Controversy still exists on likely IL-6 differences. The inadequately studied IL-8 does not seem to play an important role in immunologic differences. The immunologically beneficial IFN-gamma, produced by the principal effectors of cell-mediated immunity Th1 cells, seems to have a more active presence following laparoscopic colectomy, potentially contributing to an immunologic “advantage” by counteracting “harmful” cytokines, such as IL-1

Clinical Evaluation in Parkinson’s Disease: Is the Golden Standard Shiny Enough?

Parkinson’s disease (PD) has become the second most common neurodegenerative condition following Alzheimer’s disease (AD), exhibiting high prevalence and incident rates. Current care strategies for PD patients include brief appointments, which are sparsely allocated, at outpatient clinics, where, in the best case scenario, expert neurologists evaluate disease progression using established rating scales and patient-reported questionnaires, which have interpretability issues and are subject to recall bias. In this context, artificial-intelligence-driven telehealth solutions, such as wearable devices, have the potential to improve patient care and support physicians to manage PD more effectively by monitoring patients in their familiar environment in an objective manner. In this study, we evaluate the validity of in-office clinical assessment using the MDS-UPDRS rating scale compared to home monitoring. Elaborating the results for 20 patients with Parkinson’s disease, we observed moderate to strong correlations for most symptoms (bradykinesia, rest tremor, gait impairment, and freezing of gait), as well as for fluctuating conditions (dyskinesia and OFF). In addition, we identified for the first time the existence of an index capable of remotely measuring patients’ quality of life. In summary, an in-office examination is only partially representative of most PD symptoms and cannot accurately capture daytime fluctuations and patients’ quality of life