Relationship between emergency presentation, systemic inflammatory response, and cancer-specific survival in patients undergoing potentially curative surgery for colon cancer

Background Emergency presentation is recognized to be associated with poorer cancer-specific survival following curative resection for colorectal cancer. The present study examined the hypothesis that an enhanced systemic inflammatory response, prior to surgery, might explain the impact of emergency presentation on survival. Methods In all, 188 patients undergoing potentially curative resection for colorectal cancer were studied. Of these, 55 (29%) presented as emergencies. The systemic inflammatory response was assessed using the Glasgow Prognostic Score (mGPS), which is the combination of an elevated C-reactive protein (>10 mg/L) and hypoalbuminemia (<35 g/L). Results In the emergency group, tumor stage was greater (P < 0.01), more patients received adjuvant therapy (P < 0.01) more patients had an elevated mGPS (P < 0.01), and more patients died of their disease (P < 0.05). The minimum follow-up was 12 months; the median follow-up of the survivors was 48 months. Emergency presentation was associated with poorer 3-year cancer-specific survival in those patients aged 65 to 74 years (P < 0.01), in both males and females (P < 0.05), in the deprived (P < 0.01), in patients with tumor-node-metastasis (TNM) stage II disease (P < 0.01), in those who received no adjuvant therapy (P < 0.01), and in the mGPS 0 and 1 groups (P < 0.05) groups. On multivariate survival analysis of patients undergoing potentially curative surgery for TNM stage II colon cancer, emergency presentation (P < 0.05) and mGPS (P < 0.05) were independently associated with cancer-specific survival. Conclusions These results suggest that emergency presentation and the presence of systemic inflammatory response prior to surgery are linked and account for poorer cancer-specific survival in patients undergoing potentially curative surgery for colon cancer. Both emergency presentation and an elevated mGPS should be taken into account when assessing the likely outcome of these patients

Clinical significance of hypoalbuminemia in outcome of patients with scrub typhus

<p>Abstract</p> <p>Background</p> <p>This study was designed to investigate the clinical significance of hypoalbuminemia as a marker of severity and mortality in patients with Scrub typhus.</p> <p>Methods</p> <p>The patients with scrub typhus were divided into two groups based on the serum albumin levels; Group I (serum albumin <3.0 g/dL) and Group II (serum albumin ≥3.0 g/dL). The outcome of patients with hypoalbuminemia was compared with that of normoalbuminemia.</p> <p>Results</p> <p>Of the total 246 patients who underwent the study, 84 patients (34.1%) were categorized as Group I and 162 patients were (65.9%) as Group II. Group I showed significantly higher incidence of confusion (24.6% vs. 5.3%, <it>p </it>< 0.001), pulmonary edema (15.8% vs. 3.2%, <it>p </it>= 0.002), pleural effusion (22.8% vs. 11.1%, <it>p </it>= 0.03), arrhythmia (12.3% vs. 2.6%, <it>p </it>= 0.008) and non-oliguric acute renal failure (40.4% vs. 11.1%, <it>p </it>< 0.001) compared to group II. Hypoalbuminemic group had a higher APACHE II score (11.37 ± 5.0 vs. 6.94 ± 4.2, <it>p </it>< 0.001), longer hospital stay (19.9 ± 42.1 days vs 7.5 ± 13.8 days, <it>p </it>= 0.012), and higher hospital cost compared to Group II.</p> <p>Conclusions</p> <p>This study showed hypoalbuminemia in scrub typhus was closely related to the frequency of various complication, longer hospital stay, consequently the higher medical cost, necessitating more efficient management of patients, including medical resources.</p

Efficacy and safety of preoperative preparation with Lugol''s iodine solution in euthyroid patients with Graves’ disease (LIGRADIS Trial): Study protocol for a multicenter randomized trial

Background: Currently, both the American Thyroid Association and the European Thyroid Association recommend preoperative preparation with Lugol''s Solution (LS) for patients undergoing thyroidectomy for Graves’ Disease (GD), but their recommendations are based on low-quality evidence. The LIGRADIS trial aims to provide evidence either to support or refute the systematic use of LS in euthyroid patients undergoing thyroidectomy for GD. Methods: A multicenter randomized controlled trial will be performed. Patients =18 years of age, diagnosed with GD, treated with antithyroid drugs, euthyroid and proposed for total thyroidectomy will be eligible for inclusion. Exclusion criteria will be prior thyroid or parathyroid surgery, hyperparathyroidism that requires associated parathyroidectomy, thyroid cancer that requires adding a lymph node dissection, iodine allergy, consumption of lithium or amiodarone, medically unfit patients (ASA-IV), breastfeeding women, preoperative vocal cord palsy and planned endoscopic, video-assisted or remote access surgery. Between January 2020 and January 2022, 270 patients will be randomized for either receiving or not preoperative preparation with LS. Researchers will be blinded to treatment assignment. The primary outcome will be the rate of postoperative complications: hypoparathyroidism, recurrent laryngeal nerve injury, hematoma, surgical site infection or death. Secondary outcomes will be intraoperative events (Thyroidectomy Difficulty Scale score, blood loss, recurrent laryngeal nerve neuromonitoring signal loss), operative time, postoperative length of stay, hospital readmissions, permanent complications and adverse events associated to LS. Conclusions: There is no conclusive evidence supporting the benefits of preoperative treatment with LS in this setting. This trial aims to provide new insights into future Clinical Practice Guidelines recommendations. Trial registration: ClinicalTrials.gov identifier: NCT03980132. © 202

Importance of the evaluation of serum albumin concentration in postoperative period of patients submitted to major surgeries Importância da avaliação da concentração da albumina sérica no pós-operatório de operações de grande porte

BACKGROUND: The prevalence of protein-energy malnutrition in surgical patients is high, ranging from 10% to 54%. The correct assessment of the nutritional status of such patients is crucial since malnourishment is a risk factor for morbidity and mortality. AIM: To assess the effect of surgical trauma in serum albumin concentration during the immediate postoperative period of major surgeries. METHODS: The study was conducted on 100 randomly chosen adult patients submitted to elective major surgeries, classified according to sex, age and skin color. Blood samples for the determination of serum albumin concentrations were obtained on the days before and after the surgical procedure. RESULTS: There was a reduction in serum albumin from 3.72 ± 0.47 to 2.83 ± 0.71 g/dL (P< 0.0001) with no difference in sex or skin color for major surgeries. With respect to age groups, a greater drop in albumin was observed among patients aged over 65 years, followed by younger patients (< 45 years), and finally by patients aged 45 to 65 years. CONCLUSION: Major operations lead to acute reduction in albumin concentration in the immediate postoperative period, and it was more intense in patients aged over 65 years.<br>RACIONAL: A prevalência de desnutrição energético-protéica em pacientes cirúrgicos é alta, variando entre 10% a 54%. A correta avaliação do estado nutricional desses pacientes é crucial uma vez que a desnutrição é um fator de risco para a morbidade e mortalidade. OBJETIVO: Avaliar o efeito do trauma cirúrgico na concentração sérica de albumina, durante o período pós-operatório imediato de operações de grande porte. MÉTODOS: O estudo foi conduzido em 100 pacientes escolhidos aleatoriamente adultos submetidos a procedimentos cirúrgicos eletivos de grande porte, classificados de acordo com sexo, idade e cor da pele. As amostras de sangue para a determinação da concentração sérica de albumina foram obtidas nos dias antes e após o procedimento cirúrgico. RESULTADOS: Houve diminuição da albumina sérica de 3,72 ± 0,47-2,83 ± 0,71 g / dL (P <0,0001), sem diferença de sexo ou cor da pele para operações de grande porte. Com relação à faixa etária, a maior queda da albumina foi observada entre os pacientes com idade superior a 65 anos, seguidos pelos pacientes mais jovens (<45 anos) e, finalmente, pacientes com idade entre 45-65 anos. CONCLUSÃO: As grandes operações levam à diminuição aguda na concentração de albumina no pós-operatório imediato, que foi mais intensa nos pacientes com idade superior a 65 anos