40 research outputs found
Radioiodine remnant ablation of differentiated thyroid cancer does not further increase oxidative damage to membrane lipids - early effect
<p>Abstract</p> <p>Introduction</p> <p>Radioiodine (<sup>131</sup>I) therapy is widely accepted as an essential part of therapeutic regimens in many cases of differentiated thyroid cancer. Radiation-induced oxidative damage to macromolecules is a well known phenomenon. Frequently examined process to evaluate oxidative damage to macromolecules is lipid peroxidation (LPO), resulting from oxidative damage to membrane lipids. The aim of the study was to examine serum LPO level in hypothyroid (after total thyroidectomy) cancer patients subjected to ablative activities of <sup>131</sup>I.</p> <p>Materials and methods</p> <p>The study was carried out in 21 patients (18 females and 3 males, average age 52.4 ± 16.5 years) after total thyroidectomy for papillary (17 patients) or follicular (4 patients) thyroid carcinoma. Hypothyroidism was confirmed by increased TSH blood concentration (BRAHMS, Germany), measured before <sup>131</sup>I therapy. Activity of 2.8 - 6.9 GBq of <sup>131</sup>I was administered to the patients orally as sodium iodide (OBRI, Poland). Concentrations of malondialdehyde + 4-hydroxyalkenals (MDA + 4-HDA), as an index of LPO (LPO-586 kit, Calbiochem, USA), were measured in blood serum just before <sup>131</sup>I administration (day "0") and on the days 1-4 after <sup>131</sup>I therapy. Sera from 23 euthyroid patients served as controls. Correlations between LPO and TSH or <sup>131</sup>I activity were calculated.</p> <p>Results</p> <p>Expectedly, serum LPO level, when measured before <sup>131</sup>I therapy, was several times higher (p < 0.00001) in cancer patients than in healthy subjects, which is probably due to hypothyroidism caused by total thyroidectomy. However, we did not observe any differences between LPO levels after and before <sup>131</sup>I therapy. LPO did not correlate with TSH concentration. In turn, negative correlation was found between <sup>131</sup>I activity and LPO level on the day "2" after radioiodine treatment.</p> <p>Conclusions</p> <p>Radioiodine remnant ablation of differentiated thyroid cancer does not further increase oxidative damage to membrane lipids, at least early, after therapy.</p
The influence of thiamazole, lithium carbonate, or prednisone administration on the efficacy of radioiodine treatment (131I) in hyperthyroid patients
Introduction: The effects of selected drugs (see below) on the efficacy of (131I) radioiodine therapy were examined.
Material and methods: The study involved 200 hyperthyroid patients, treated with radioactive iodine. They were divided into five groups
(40 persons in each). In Group I - patients were administered 131I and thiamazole; in Group II they were given - 131I and lithium carbonate;
in Group III they were given - 131I only (the assumed absorbed dose - 150-200 Gy, the same as in Groups I and II, for which Group III
was a control group); in Group IV they were given - 131I and prednisone; and in Group V they were given - 131I only (250-350 Gy, the
same as in Group IV, for which Group V was a control group). Therapeutic results were analyzed after six months based on clinical and
hormonal status. The evaluation also included effects of the initial hormonal status on the outcome of 131I therapy in Groups II and IV
(v. respective controls, i.e. Groups III and V); such analysis was not performed in Group I because all the patients in that group were
initially hyperthyroid.
Results: In 145 patients (72.5%) the therapy with 131I was effective. In 55 patients (27.5%) the therapy was ineffective. The application of
thiamazole during the peritherapeutic period in patients treated with 131I reduced the effectiveness of radioiodine, while lithium carbonate
had no effect on the therapy outcome. Prednisone increased the effectiveness of the therapy with 131I. Normalisation of the initial concentration
of TSH was advantageous for the 131I therapeutic outcome only when the assumed absorbed doses of 150–200 Gy were applied,
while being of no avail for doses above 250 Gy.
Conclusions: The present results indicate the necessity of careful analysis of administered drugs in hyperthyroid patients while qualifying
them to 131I therapy. The initial concentration of TSH has no effect on the efficacy of radioiodine therapy in cases where absorbed doses are
regarded to be ablative.
(Pol J Endocrinol 2010; 61 (1): 56-61)Wstęp: W pracy zbadano wpływ tiamazolu, węglanu litu i prednizonu na skuteczność leczenia jodem radioaktywnym pacjentów z nadczynnością
tarczycy.
Materiał i metody: Do badań zakwalifikowano 200 chorych z nadczynnością tarczycy, leczonych jodem radioaktywnym. Pacjentów
podzielono na 5 grup (40 osób w każdej). W grupie I - poza 131I - chorzy dodatkowo otrzymywali tiamazol (preparat Thyrozol), w grupie II
- oprócz 131I - węglan litu. Do grupy III zaliczono chorych, którzy otrzymali wyłącznie leczenie 131I przy założonej dawce pochłoniętej
150-200 Gy, czyli takiej samej, jak w grupie I i II; grupa III stanowiła grupę kontrolną dla tych dwóch grup. W grupie IV chorzy otrzymywali
leczenie 131I oraz - w okresie okołoterapeutycznym - prednizon w dawce 1 mg/kg mc. W grupie V - chorzy otrzymali wyłącznie
leczenie 131I (założona dawka pochłonięta 250-300 Gy), tak samo jak w grupie IV; grupa V stanowiła kontrolę dla grupy IV. Wyniki
leczenia zanalizowano po sześciu miesiącach na podstawie badania klinicznego i hormonalnego. Do oceny włączono także wpływ początkowego
stanu hormonalnego na skuteczność terapii 131I w grupach II i IV (względem odpowiednich grup kontrolnych, tj. grupy III i V). Takiej
analizy nie przeprowadzono w grupie I, ponieważ wszyscy pacjenci w tej grupie mieli początkowo nadczynność tarczycy.
Wyniki: U 145 pacjentów (72,5%) terapia 131I była skuteczna. U 55 pacjentów (27,5%) terapia okazała się nieskuteczna. Zastosowanie
tiamazolu w okresie okołoterapeutycznym u pacjentów leczonych 131I zmniejszyło skuteczność radiojodu, podczas gdy leczenie węglanem
litu nie miało wpływu na wyniki terapii. Prednizon zwiększył skuteczność leczenia 131I. Normalizacja początkowego stężenia hormonu
tyreotropowego (TSH, thyroid stimulating hormone) wpływała korzystnie na wynik leczenia 131I tylko wtedy, gdy założona dawka pochłonięta
wynosiła 150-200 Gy, podczas gdy dla dawek powyżej 250 Gy korzystnego wpływu nie stwierdzono.
Wnioski: Wyniki pracy - będąc potwierdzeniem korzystnego wpływu steroidów i niekorzystnego wpływu leków przeciwtarczycowych
na skuteczność 131I u pacjentów z nadczynnością tarczycy - wskazują na konieczność dokładnej analizy leków przyjmowanych
przez pacjentów podczas kwalifikacji do terapii radiojodem. Początkowe stężenie TSH nie ma wpływu na skuteczność leczenia radiojodem,
w przypadku kiedy dawki pochłonięte są zbliżone do dawek ablacyjnych. (Endokrynol Pol 2010; 61 (1): 56-61
Comparison of the yeast microbiota of different varieties of cool-climate grapes by PCR-RAPD
The yeast microbiota occurring on different varieties of grapes grown in cool-climate is not completely researched. Therefore, its identification is important to research. On the other hand, yeasts occurring in these fruits can be potentially used as starter cultures to obtain particularly demanded features in the production of wine. In addition, rapid methods for yeast identification allow to eliminate the contamination with pathogenic yeasts, which could cause the loss of wine production. The aim of the study was to isolate and identify the yeasts occurring on the surface of the different varieties of white and red grapes, grown in cool-climate of Poland. Also, the aim was to compare the qualitative and quantitative composition of yeasts on the tested grapes. The 84 cultures of yeasts were isolated, that were initially macroscopic and microscopic analyzed and the purity of cultures was rated on the WL medium. Identification of yeasts by PCR-RAPD was carried using the M13 primer. In the PCR-RFLP method ITS1 and ITS4 primers, as well as restriction enzymes HhaI, HinfI, HaeIII, were used. Preliminary identification of yeasts by standard methods produced results very different from the results obtained by molecular methods. Among the isolated microorganisms yeasts were dominating, but bacteria and molds were also present. Using the PCR-RAPD method most strains of yeasts were identified. Yeast microflora of different varieties of white and red grapes was very similar as the same species of yeasts were identified. Yeasts of the genus Saccharomyces were present in all varieties of grapes. The Rhodotorula mucilaginosa, Saccharomyces cerevisiae, Metschnikowia pulcherrima, Rhodotorula minuta, Pichia kluyveri, Hanseniaspora uvarum and Rhodotorula mucilaginosa were identified by PCR-RAPD. 4 of the 33 tested strains of yeasts were identified by PCR-RFLP. By PCR-RAPD only Hanseniaspora uvarum was identified. The quantity and quality of microorganisms living on the surface of grape fruits is very important for the process of winemaking. Yeasts influence the course of alcoholic fermentation, the flavor, aroma, and thus the quality of the produced wine. To a large extent their presence depends on the condition of the surface of the fruit. Many researchers reported significant differences between yeast microflora in grapes of Mediterranean and cool-climate vineyards. As they are expected to affect the final wine properties precise researching of the microflora of cool-climate grapes may lead to the isolation of new species of yeasts and thus the wines with unique characteristics can be obtained
An evaluation of the value of first thyroglobulin determination in the diagnostics of metastases immediately following differentiated thyroid carcinoma surgery
Wstęp: Celem pracy była ocena wartości różnicowej pierwszego
oznaczenia stężenia tyreoglobuliny (Tg) po tyreoidektomii
(Tx), a przed ablacją kikutów tarczycy u chorych ze
zróżnicowanym rakiem tarczycy (DTC, differentiated thyroid
carcinoma) jako wskaźnika obecności przerzutów i/lub
ognisk nowotworowych (M).
Materiał i metoda: Retrospektywnej analizie poddano dane
517 chorych po Tx z powodu DTC skierowanych w celu
ablacji kikutów tarczycy, obserwowanych następnie dłużej
niż 1,5 roku. Z analizy wykluczono pacjentów o niepewnym
przebiegu choroby i z interferencją w badaniu Tg
(a-TgAb[+], odzysk Tg < 80%). Ostatecznie analizowano
wyniki 247 chorych z DTC (14-79 lat; 223 kobiet, 24 mężczyzn). Porównano wyniki badań TSH, wychwytu 131I nad
szyją (Tup24), objętości resztek tarczycy (V) i Tg u chorych
z rozpoznanymi w chwili badania M (Grupa M1; n = 35)
z tymi samymi parametrami u pacjentów bez obserwowanego
powyżej 1,5 roku nawrotu choroby (Grupa M0; n = 212).
Obliczono pole pod krzywą ROC stężeń Tg w badanej grupie.
Wyznaczono wartość referencyjną stężenia Tg dla podejrzenia
M za pomocą krzywej wydajności badania Tg.
Wyniki: Grupy M0 i M1 nie różniły się pod względem stężenia TSH (mediana 49,7 jm./l vs. 44,3; p = 0,16), objętości
kikutów tarczycy (1,4 vs. 1,1 ml; p = 0,79), różnice dotyczyły
natomiast Tup24 (7,6 vs. 3,2%; p = 0,01) oraz Tg (4,5 vs. 96,7 ng/ml; p = 0,000000). Pole pod krzywą ROC dla Tg dla
badanej grupy wynosiło 0,78 ± 0,05 (śr. ± s.e.m.). Wartość
referencyjną Tg dla podejrzenia M wyznaczono na 38,1 ng/ml,
czułość oznaczenia Tg wynosiła 0,57 (95%CI 0,39-0,74),
a swoistość 0,96 (95%CI 0,92-0,98).
Wnioski: Pierwsze stężenie Tg oznaczone po Tx przybiera
u chorych z przerzutami raka tarczycy wartości większe niż
u chorych bez tych przerzutów, co wskazuje, iż wymieniony
parametr może być stosowany jako wczesny wskaźnik
obecności przerzutów raka tarczycy (również w obecności
kikutów tarczycy).Introduction: Evaluation of the differential value of the first
thyroglobulin (Tg) concentration, measured after thyroidectomy
(Tx) but before thyroid remnant ablation, in patients
with differentiated thyroid carcinoma (DTC) as a marker of
either metastases or residual cancer (M).
Material and methods: Data from 517 patients with DTC
after Tx, with follow-up > 1.5 year were analysed retrospectively.
Patients in whom either the course of the disease was
unclear or interference in the Tg test was possible (a-TgAb
[+], Tg recovery < 80%) were excluded from the study. Finally,
the data from 247 patients were evaluated (age: 14-79 years; 223 women, 24 men). The results of TSH, thyroid
radioiodine uptake (Tup24), thyroid remnant volume (V) and
Tg in patients with diagnosed M (group M1; n = 35) were
compared with the same parameters in patients with remission
> 1.5 year (group M0; n = 212). The area under the
ROC curve was calculated. The clinical decision limit of Tg
level to be suggestive of metastases was determined by
means of efficiency curve.
Results: Groups M0 and M1 did not differ from each other
with respect to TSH concentration (median 49.7 mIU/l vs
44.3; p = 0.16) or thyroid remnant volume (1.4 vs 1.1 ml;
p = 0.79). However, they did differ with respect to Tup24 (7.6 vs 3.2%; p = 0.01) and Tg (4.5 vs 96.7 ng/ml;
p = 0.000000). Area under ROC for Tg was 0.78 ± 0.05 (mean ± s.e.m.). The decision limit of Tg for suspected M was determined
at 38.1 ng/ml, Tg sensitivity was 0.57 (95%CI 0.39-0.74) and specificity 0.96 (95%CI 0.92-0.98).
Conclusions: First thyroglobulin concentration, determined
after thyroidectomy but before other treatment, is higher
in patients with metastatic DTC than in patients without
such metastases. This indicates that Tg level may be used as
an early marker of either residual or metastatic DTC (even
if thyroid remnants are present)
Jakość i proces starzenia się chlebów z razowych mąk pszennych: z pszenicy zwyczajnej i orkisz oraz z żyta. Quality and Aging of Bread from Wholemeal Common Wheat and Spelt Flours, and from Wholemeal Rye Flour
Celem pracy była ocena jakości chlebów z razowej mąki pszennej z pszenicy zwyczajnej i orkiszowej oraz z żyta, uzyskanych na zakwasie spontanicznym z mąki razowej z danego zboża oraz określenie procesu starzenia się tego pieczywa w trakcie przechowywania. W piekarni "Vini" sporządzono z wymienionych trzech mąk razowych zakwasy spontaniczne i dodano je w odpowiedniej proporcji do sporządzenia ciasta. Z 600-gramowych kęsów ciasta wypieczono chleby i po ochłodzeniu oznaczono ich masę, zmierzono objętość, wyliczono stratę wypiekową całkowitą oraz wykonano ocenę organoleptyczną. We wszystkich chlebach oznaczono zawartość: wody, białka ogółem, błonnika pokarmowego (frakcji rozpuszczalnej i nierozpuszczalnej), popiołu (wybranych makro- i mikroelementów), tłuszczu surowego, wybranych mikotoksyn, fosforanów mio-inozytolu, substancji kształtujących smak i zapach oraz akryloamidu. Wykonano również pomiary profilu tekstury miękiszu w dniu wypieku oraz podczas 7-dobowego przechowywania. Oznaczono liczbę tlenowych bakterii amylolitycznych (OLBA), liczbę tlenowych przetrwalnikujących bakterii amylolitycznych (OLBAP), liczbę drożdży i pleśni (OLG) w 1 g pieczywa oraz trwałość termostatową pieczywa po 1., 2., 5. i 7. dobie przechowywania. Największą objętością wyróżniały się chleby z mąki z pszenicy zwyczajnej graham i one też uzyskały najlepszą akceptację konsumentów w ocenie organoleptycznej, zwłaszcza za smak i zapach. Chleby żytnie i z mąki z pszenicy orkisz cechowały się podobną objętością bochenków, przy czym chleby żytnie w większym stopniu niż orkiszowe były akceptowane przez konsumentów. W chlebach z mąki pszennej, zarówno graham, jak i orkiszowej oznaczono zbliżony stosunek zawartości kwasu mlekowego do octowego - średnio 78 : 22, natomiast w chlebie żytnim udział kwasu mlekowego był mniejszy, octowego - większy niż w pieczywie pszennym, a stosunek zawartości kwasu mlekowego do octowego wynosił średnio 68 : 32. W chlebie razowym żytnim oznaczono największą zawartość glukozy. W chlebach razowych pszennych, zarówno orkiszowych, jak i graham, w odróżnieniu od chlebów żytnich, oznaczono zarówno niższe fosforany mio-inozytolu (IP3 i IP2), jak i wyższe fosforany tego związku - IP5 i IP4. W razowych chlebach orkiszowych nie oznaczono nawet śladowych zawartości akryloamidu, a w pozostałych chlebach ilości tego związku były śladowe. Badane chleby wykazały dużą trwałość mikrobiologiczną. W dniu wypieku największą wilgotnością miękiszu odznaczały się chleby żytnie (ok. 50 %), natomiast średnia wilgotność miękiszu chlebów pszennych (orkiszowych i graham) wynosiła ok. 47,5 %. Po 7 dobach przechowywania wilgotność miękiszu wszystkich chlebów zmniejszyła się w bardzo małym stopniu - o 0,5 ÷ 1 p.p., mimo to zaobserwowano postępujący wzrost jego twardości podczas przechowywania, najmniejszy w chlebach żytnich. (abstrakt oryginalny)
The objective of the research study was to assess the quality of bread baked from wholemeal common wheat and spelt wheat wholemeal flours, and from a rye wholemeal flour using a spontaneous sourdough based on the respective wholemeal flour derived from a given cereal, and to determine the aging process of this bread during storage. In a conventional bakery, spontaneous sourdough starters were made from the above named three types of flour and added to the dough in an appropriate proportion. The 600 g pieces of the dough were baked and, after cooling, their weight was determined, their volume was measured, a baking loss was calculated, and an organoleptic assessment was performed. In all the bread loaves, there were determined the contents of: water, total protein, dietary fibre (soluble and insoluble fractions), ash (of the selected macro- and microelements), raw fat, some selected micotoxins, myoinositol phospates, substances that give bread its taste and aroma, and acrylamid. Also, the texture profile of bread crumb was measured on the day of baking and during a 7 day period of storage. Moreover, in 1 g of bread, the count of aerobic amylolytic bacteria (OLBA) was determined as were the counts of sporeforming aerobic amylolytic bacteria (OLBAP), yeasts and moulds (OLG); the thermostatic stability of bread was determined after the 1st, 2nd, 5th, and 7th day of storage. Bread baked from the common wheat Graham flour was characterized by the highest volume and the samples of this bread received, especially for its smell and taste, the highest acceptance of the consumers, who assessed them organoleptically. The rye and spelt bread loaves were characterized by a comparable loaf volume; however, the rye bread was accepted higher by the consumers than the spelt bread. In the bread made from both the common wheat and spelt wheat flour, a similar ratio was determined of lactic to acetic acid (68/32, on average). The highest level of glucose was measured in the rye bread. In contrast to the rye bread, in the bread produced from common and spelt wholemeal flours, there were determined lower contents of myo-inositol phosphates (IP3 and IP2) and higher contents of phosphates of that compound (IP5 and IP4). In the bread from spelt wholemeal flour, even trace contents of acrylamide were not found, and in the other bread loaves, trace amounts of this compound were determined. The bread analysed had a high microbiological stability. On the day of baking, the highest moisture content was reported in the rye bread loaves (approx. 50 %) while the average content of moisture was 47.5 % in the crumb of wheat bread (from common Graham and spelt wheat flour). After 7 days of storage, the moisture content in all the bread loaves decreased to a very low degree: 0.5 to 1 p.p., although their crumbs progressively hardened during storage; the rye bread crumb hardened the slowest. (original abstract
Zastosowanie kwasu 13-cis-retinowego u pacjentów z niejodochwytnymi przerzutami zróżnicowanego raka tarczycy
Introduction: The loss of iodine uptake by differentiated
thyroid carcinoma (DTC) cells is a major therapeutic problem
especially in patients with nonsurgical metastatic foci
or local recurrence. Using 13-cis-retinoic acid, it was attempted
to retain iodine uptake as a result of redifferentiation
(influence by retinoic acid receptors present in DTC cells).
Material and methods: Between 1999 and 2005, 13-cis-retinoic
acid was used in 11 patients with disseminated PTC
and high serum level of thyroglobulin (Tg) before 131I treatment
(2 patients were treated twice - 13 treatment cycles
in total). Side effects in skin and mucous membranes were
observed in all the patients, however, their intensity did
not require termination of the therapy.
Results: Increase of iodine uptake was observed in 5 patients
(45%). Decreased Tg concentration was observed in
9 patients. In that group, increased 131I uptake was observed
in 4 patients with distant metastases. All determinations of
Tg concentrations were carried out under TSH stimulation.
Conclusions: 13-cis-retinoic acid causes an increase of radioiodine
uptake in around half of treated patients, however, the follow-up of these patients indicates that this increase
does not result in either full remission or even stabilisation
of neoplastic disease.
The possibility should be considered to use cis-retinoic acid
as an independent therapeutic approach in patients with
radioiodine non-avid foci of thyroid carcinoma especially
those showing high expression of RARb and RXRg receptors.Wstęp: Utrata jodochwytności przez komórki zróżnicowanego
raka tarczycy (DTC, differentiated thyroid carcinoma) jest
powa¿nym problemem terapeutycznym, zwłaszcza u pacjentów z nieoperacyjnymi ogniskami przerzutowymi lub
wznową miejscową. Zastosowanie kwasu 13-cis-retinowego
było próbą przywrócenia wychwytu 131I w wyniku zwiększenia
stopnia zróżnicowania raka (wpływ na receptory
kwasu retinowego, obecne w komórkach DTC).
Materiał i metody: W latach 1999-2005 u 11 chorych z rozsianym
procesem nowotworowym i wysokimi stężeniami
tyreoglobuliny (Tg, thyroglobulin) zastosowano kwas 13-cis-retinowy (preparat Roaccutan) przed podaniem 131I (2 chorych
leczono 2-krotnie - łącznie 13 cykli leczenia).
U wszystkich pacjentów obserwowano działania niepożądane ze strony skóry i błon śluzowych, jednak ich nasilenie
nie stanowiło wskazań do zaprzestania terapii.
Wyniki: Wzrost jodochwytności zaobserwowano u 5 chorych
(45%), spośród których u 4 uzyskane zwiększenie
wychwytu dotyczyło części stwierdzanych przerzutów, natomiast
w 1 przypadku dotyczyło wychwytu w obrębie
wznowy miejscowej. U 9 pacjentów stwierdzono obniżenie
stężenia Tg (82%). W tej samej grupie u 4 chorych - u pacjentów z przerzutami odległymi - obserwowano wzrost
wychwytu 131I . U 2 pacjentów wystąpił wzrost stężenia Tg,
a zwiększoną jodochwytność wznowy miejscowej stwierdzono
w 1 przypadku. Wszystkie oznaczenia stężeń Tg przeprowadzono w czasie stymulacji hormonu tyreotropowego
(TSH, thyroid stimulating hormone).
Wnioski: Zastosowanie kwasu 13-cis-retinowego u około
połowy leczonych chorych powoduje wzrost jodochwytności, jednak w późniejszej obserwacji pacjentów wykazano,
że wzrost ten nie umożliwia uzyskania pełnej remisji
czy nawet stabilizacji choroby nowotworowej.
Należy natomiast rozważyć możliwość zastosowania kwasu
cis-retinowego jako niezależnego od innych form leczenia
elementu postępowania terapeutycznego u pacjentów
z niejodochwytnymi ogniskami raka tarczycy, zwłaszcza
w sytuacji wysokiej ekspresji receptorów RARb i RXRg
w tych guzach
The significant impact of age on the clinical outcomes of laparoscopic appendectomy : results from the Polish Laparoscopic Appendectomy multicenter large cohort study
Acute appendicitis (AA) is the most common surgical emergency and can occur at any age. Nearly all of the studies comparing outcomes of appendectomy between younger and older patients set cut-off point at 65 years. In this multicenter observational study, we aimed to compare laparoscopic appendectomy for AA in various groups of patients with particular interest in the elderly and very elderly in comparison to younger adults. Our multicenter observational study of 18 surgical units assessed the outcomes of 4618 laparoscopic appendectomies for AA. Patients were divided in 4 groups according to their age: Group 1- 8 days. Logistic regression models comparing perioperative results of each of the 3 oldest groups compared with the youngest one showed significant differences in odds ratios of symptoms lasting >48hours, presence of complicated appendicitis, perioperative morbidity, conversion rate, prolonged LOS (>8 days). The findings of this study confirm that the outcomes of laparoscopic approach to AA in different age groups are not the same regarding outcomes and the clinical picture. Older patients are at high risk both in the preoperative, intraoperative, and postoperative period. The differences are visible already at the age of 40 years old. Since delayed diagnosis and postponed surgery result in the development of complicated appendicitis, more effort should be placed in improving treatment patterns for the elderly and their clinical outcome
Risk factors for serious morbidity, prolonged length of stay and hospital readmission after laparoscopic appendectomy : results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study
Laparoscopic appendectomy (LA) for treatment of acute appendicitis has gained acceptance with its considerable benefits over open appendectomy. LA, however, can involve some adverse outcomes: morbidity, prolonged length of hospital stay (LOS) and hospital readmission. Identification of predictive factors may help to identify and tailor treatment for patients with higher risk of these adverse events. Our aim was to identify risk factors for serious morbidity, prolonged LOS and hospital readmission after LA. A database compiled information of patients admitted for acute appendicitis from eighteen Polish and German surgical centers. It included factors related to the patient characteristics, peri- and postoperative period. Univariate and multivariate logistic regression models were used to identify risk factors for serious perioperative complications, prolonged LOS, and hospital readmissions in acute appendicitis cases. 4618 laparoscopic appendectomy patients were included. First, although several risk factors for serious perioperative complications (C-D III-V) were found in the univariate analysis, in the multivariate model only the presence of intraoperative adverse events (OR 4.09, 95% CI 1.32-12.65, p = 0.014) and complicated appendicitis (OR 3.63, 95% CI 1.74-7.61, p = 0.001) was statistically significant. Second, prolonged LOS was associated with the presence of complicated appendicitis (OR 2.8, 95%CI: 1.53-5.12, p = 0.001), postoperative morbidity (OR 5.01, 95% CI: 2.33-10.75, p < 0.001), conversions (OR 6.48, 95% CI: 3.48-12.08, p < 0.001) and reinterventions after primary procedure (OR 8.79, 95% CI: 3.2-24.14, p < 0.001) in the multivariate model. Third, although several risk factors for hospital readmissions were found in univariate analysis, in the multivariate model only the presence of postoperative complications (OR 10.33, 95% CI: 4.27-25.00), reintervention after primary procedure (OR 5.62, 95% CI: 2.17-14.54), and LA performed by resident (OR 1.96, 95%CI: 1.03-3.70) remained significant. Laparoscopic appendectomy is a safe procedure associated with low rates of complications, prolonged LOS, and readmissions. Risk factors for these adverse events include complicated appendicitis, postoperative morbidity, conversion, and re-intervention after the primary procedure. Any occurrence of these factors during treatment should alert the healthcare team to identify the patients that require more customized treatment to minimize the risk for adverse outcomes