Laparoscopic versus Open Appendectomy: Where Are We Now?

Rezumat Apendicectomia prin abord laparoscopic versus abord deschis: pentru ce optãm? Scop: Deaei avantajele procedurilor laparoscopice au fost intens studiate pe parcursul ultimelor douã decenii, apendicectomia laparoscopicã nu a putut fi desemnatã ca procedurã standard de tratament din cauza unor dezavantaje de tipul timpilor operatori aei al costurilor crescute. Obiectivul studiului nostru este de a reevalua rezultatele pe termen lung ale abordului laparoscopic versus cel chirurgical deschis pentru aceastã patologie pe baza datelor actuale. Metode: Datele pacienåilor supuaei apendicectomiei între ianuarie 2012 aei iulie 2012 au fost analizate prospectiv. Datele demografice ale pacienåilor, durata procedurii, perioada de internare, nevoia de analgezice, scorul VAS aei rata mortalitãåii au fost înregistrate. Rezultate: Din 241 de pacienåi, 120 (49.8%) au suferit intervenåie deschisã aei 121 (50.2%) au fost operaåi laparoscopic. Perioada intervenåiei a fost similarã între cele douã grupuri (p=0.855). Scorurile VAS dupã prima orã (p=0.001), dupã 6 (p=0.001) aei dupã 12 ore de la operaåie (p=0.028) au fost mai mari în grupul de apendicectomii prin abord deschis (p=0.001). Nu au existat diferenåe statistice vizând ratele de morbiditate între grupul prin abord deschis aei cel prin abord laparoscopic (p=0.617). Concluzii: Cele douã tehnici operatorii sunt similare în ceea ce priveaete perioada de internare, durata operaåiei aei complicaåiile postoperatorii. Apendicectomia laparoscopicã reduce nevoia de analgezice aei scorurile VAS; aceasta ar trebui prin urmare luatã în considerare ca standard de aur în tratamentul chirurgical al apendicitei acute. Cuvinte cheie: apendicitã, apendicectomie, procedurã laparoscopicã, abces abdominal, infecåia plãgii chirurgicale Abstract Purpose: Although the advantages of laparoscopic procedures has been well studied over the last two decade, laparoscopic appendectomy could not to be a standard therapy due to some disadvantages such as longer operative time and higher cost. The objective of our study is to re-evaluate the outcomes of laparoscopic versus open appendectomy with current data. Methods: Between January 2012 and July 2012, the data of the patients who had appendectomy were recorded prospectively. Patients' demographics, duration of procedure, length of hospital stay, need of analgesics, postoperative visual analogue scale scores and morbidity were assessed

Core Needle Biopsy in the Diagnosis of Thyroid Nodules

Background Core needle biopsy (CNB) is a relatively new technique for the diagnosis of thyroid nodules, and there are currently no large clinical series available. CNB results from 3000 cases are presented in this article. Methods A spring-loaded 20-gauge needle was used for CNB under local anesthesia and ultrasonography guidance for 3000 patients with nodular goiter (584 males, 2416 females, mean age: 48.5). One physician performed all biopsy procedures without conducting on-site pathological examinations. Results There were non-diagnostic 22 (.7%), benign 2620 (87.4%), atypia of undetermined significance and/or, follicular lesion of undetermined significance 90 (3%), follicular neoplasms and/or suspicious for follicular neoplasm 53 (1.7%), suspicious for malignancy 160 (5.4%), and malignant 55 (1.8%) cases. The CNB procedure was repeated in 19 non-diagnostic cases, and 17 of these patients were benign and two had malignancy. Thyroidectomy was performed on patients who had malign CNB results. All final pathology reports, except for one, were malignant for the patients who had malignant CNB results. The specificity and the sensitivity of CNB were found to be 99.9% and 100%, respectively. There were no serious complications. Conclusion In thyroid nodules, core needle biopsy is a highly sensitive, specific, and reliable method that could be performed by a single physician. It does not require on-site pathological analysis and has a low incidence of complications and non-diagnostic rates

Immunophenotyping of lymphocytes and monocytes and the status of cytokines in the clinical course of Covid-19 patients

Lymphopenia, T cell subgroup changes, and cytokine level differences are important in the early diagnosis and treatment of Covid-19 cases and similar pandemics. We aimed to investigate the T cell, monocyte subgroups, and cytokine differences according to disease severity. A total of 46 volunteers were included in the study. According to disease status, there were three groups (control, mild, and severe). The age, gender, smoking status, temperature, heart rate and oxygen saturation, complete blood count, C-reactive protein (CRP) was noted, and flow cytometric analyses were performed for T cell and monocyte subgroups, and cytokine levels. Temperature, heart rate, SPO2, white blood cell (WBC), lympocyte count, trombocyte count, neutrophil/lymphocyte ratio, D-dimer and CRP levels, lymphocyte %, lymphocyte/monocyte rate, monocyte subtypes (%), CD3(+), CD4(+), CD8(+) cell counts, interleukin (IL)-1 beta, TNF-alpha, monocyte chemoattractant protein (MCP)-1, IL-6, IL-8, IL-10, IL-18, IL-23 were significantly different between groups. CRP, IL-8, neutrophil/lymphocyte ratio, NK cells (%) have positive correlation and negative correlation was observed at lymphocyte (count), lymphocyte (%), lymphocyte/monocyte, classical monocyte (%), lymphocyte (count), CD3(+) (count), CD4(+) (count). As conclusion, lymphocyte (%), Lymphocyte (count), CRP levels, CD3(+) and CD4(+) cell counts strongly correlate with disease severity are valuable parameters for determining the prognoses of Covid-19

Paleoenvironmental responses to Late Cretaceous Oceanic Anoxic Event 2 on the Kerguelen Plateau

Oceanic Anoxic Event 2 (OAE-2, ~94 Ma: late Cretaceous) was characterized by a perturbation in seawater chemistry, an expansion of marine anoxia and euxinia, an increase in marine organic-carbon burial, a decrease in atmospheric pCO2 during an interval of high global temperatures, an extinction event among marine organisms, and changes in weathering intensity. However, many of the most detailed studies of OAE-2 are from the northern hemisphere, and consequently how global environmental changes were expressed at the local and regional scale in the southern hemisphere is poorly understood. A detailed geochemical, petrographic and micropalaeontological dataset from Ocean Drilling Program Site 1138 on the Kerguelen Plateau, southern Indian Ocean (53.5oS paleolatitude), identifies OAE-2 from a 3\u2030 positive carbon-isotope excursion (CIE) and from high-resolution nannofossil biostratigraphy. An enrichment of organic carbon (to ~15%) corresponds with a shift towards locally sub-oxic/anoxic conditions, as recorded by trace-metal enrichments and molybdenum-isotope compositions. The redox changes coincide stratigraphically with an abrupt decline in the delivery of highly weathered detrital material and terrestrial organic matter to Site 1138. A rapid relative sea-level rise occurring around the onset of OAE-2 could have reduced the input of highly weathered detrital sediments, while moving the local seafloor deeper into an oxygen minimum zone impinging on the margins of the Kerguelen Plateau. Alternatively, or additionally, intensified mid-latitude hydrological cycling in the early stages of OAE-2 could have rapidly destabilized terrestrial sediments from sub-aerial landmasses on the Kerguelen Plateau. In either case, the new datasets highlight the abrupt nature of the palaeoenvironmental response to OAE-2 in the mid-latitude southern hemisphere

Climate-driven coupling of weathering and carbon burial across the Cenomanian: Turonian boundary at ODP Site 1138 (Kerguelen Plateau)

Despite its assumed global nature, there are few detailed stratigraphic records [...]