Current evidence on laparoscopic vs. open resection for gastric stromal tumours

Although the use of laparoscopic surgery is increasing, controversy still surrounds its application for malignant conditions. Gastrointestinal stromal tumours (GISTs) are less demanding in terms of lymphadenectomy, meaning that laparoscopic resection might have a more defined benefit when compared with open resection. To the best of our knowledge, no randomized study exists that compares the laparoscopic and open resection of GISTs. The current study aimed to examine the relevant literature by means of a systematic review. A systematic literature search was performed individually by two authors, in which three independent databases were searched using specific search-terms. Titles, abstracts and full texts were screened, as well as references to relevant articles, in order to comprise a comprehensive list of studies. Data were extracted using a detailed pre-agreed spreadsheet. Studies were evaluated according to the modified MINORS criteria. A total of 10 studies were included in the present review, yielding a total of 14 entries. The majority of studies reported significantly improved perioperative outcomes for the laparoscopic approach, including improved duration of operation, blood loss and length of hospital stay. Only four studies reported long-term outcomes and findings that were controversial, with some studies detecting no statistically significant differences, one reporting improved and one reporting worse disease-free and overall survival for the laparoscopic group. Three studies were deemed to be good quality, two of which had not reported significantly different long-term outcomes, while the third had reported significantly improved outcomes in the open resection group. While there is a clear benefit for performing laparoscopic surgery in patients with GIST with regards to perioperative outcomes, when it comes to long-term oncological outcomes, uncertainty over its application remains. The lack of randomized trials, as well as the poor reporting of retrospective studies, limits the amount of evidence that is currently available. Laparoscopic surgery for GIST is certainly safe, feasible and likely cost-effective; however, further studies are required to inform on whether this technique is superior to open resection

Angiomyofibroblastoma of the spermatic cord: a case report

<p>Abstract</p> <p>Introduction</p> <p>Angiomyofibroblastoma is a benign soft tissue tumor with tendency to arise in the vulva.</p> <p>Case presentation</p> <p>We report a 36-year-old Greek Caucasian man presenting with a left inguinal painless mass. This is the second case of angiomyofibroblastoma of the spermatic cord. At operation, a 4.5 cm well-circumscribed solid tumor was found adherent to the spermatic cord. The tumor consisted of spindle-shaped cells proliferating in short fascicles between numerous medium-sized blood vessels with thin and hyalinized walls. Neoplastic cells had eosinophilic cytoplasm with neither mitotic figures nor nuclear atypia. The stroma included abundant mast cells and few mature lypocytes. Immunostaining showed positivity for vimentin, CD34, desmin and smooth muscle actin. Our patient was treated by simple excision and was followed up for five years with clinical examination and ultrasonography, revealing no evidence of local recurrence or metastasis.</p> <p>Conclusion</p> <p>This unusual neoplasm should be distinguished from aggressive angiomyxoma and other myxoid malignant tumors with widespread metastatic potential.</p

Surgical Outcomes in Syndromic Tetralogy of Fallot: A Systematic Review and Evidence Quality Assessment

Tetralogy of Fallot (ToF) is one of the most common cyanotic congenital heart defects. We sought to summarize all available data regarding the epidemiology and perioperative outcomes of syndromic ToF patients. A PRISMA-compliant systematic literature review of PubMed and Cochrane Library was performed. Twelve original studies were included. The incidence of syndromic ToF was 15.3% (n = 549/3597). The most prevalent genetic syndromes were 22q11.2 deletion (47.8%; 95% CI 43.4–52.2) and trisomy 21 (41.9%; 95% CI 37.7–46.3). Complete surgical repair was performed in 75.2% of the patients (n = 161/214; 95% CI 69.0–80.1) and staged repair in 24.8% (n = 53/214; 95 CI 19.4–30.9). Relief of RVOT obstruction was performed with transannular patch in 64.7% (n = 79/122; 95% CI 55.9–72.7) of the patients, pulmonary valve-sparing technique in 17.2% (n = 21/122; 95% CI 11.5–24.9), and RV-PA conduit in 18.0% (n = 22/122; 95% CI 12.1–25.9). Pleural effusions were the most common postoperative complications (n = 28/549; 5.1%; 95% CI 3.5–7.3). Reoperations were performed in 4.4% (n = 24/549; 95% CI 2.9–6.4) of the patients. All-cause mortality rate was 9.8% (n = 51/521; 95% CI 7.5–12.7). Genetic syndromes are seen in approximately 15% of ToF patients. Long-term survival exceeds 90%, suggesting that surgical management should be dictated by anatomy regardless of genetics

Oxidative and pre-inflammatory stress in wedge resection of pulmonary parenchyma using the radiofrequency ablation technique in a swine model

<p>Abstract</p> <p>Background</p> <p>Radiofrequency ablation (RFA) is a thermal energy delivery system used for coagulative cellular destruction of small tumors through percutaneous or intraoperative application of its needle electrode to the target area, and for assisting partial resection of liver and kidney. We tried to evaluate the regional oxidative and pre-inflammatory stress of RFA-assisted wedge lung resection, by measuring the MDA and tumor Necrosis Factor Alpha (TNF-α) concentration in the resected lung tissue of a swine model.</p> <p>Method</p> <p>Fourteen white male swines, divided in two groups, the RFA-group and the control group (C-group) underwent a small left thoracotomy and wedge lung resection of the lingula. The wedge resection in the RFA-group was performed using the RFA technique whereas in C-group the simple "cut and sew" method was performed. We measured the malondialdehyde (MDA) and TNF-α concentration in the resected lung tissue of both groups.</p> <p>Results</p> <p>In C-group the MDA mean deviation rate was 113 ± 42.6 whereas in RFA-group the MDA mean deviation rate was significantly higher 353 ± 184 (p = 0.006). A statistically significant increase in TNF-α levels was also observed in the RFA-group (5.25 ± 1.36) compared to C-group (mean ± SD = 8.48 ± 2.82) (p = 0.006).</p> <p>Conclusion</p> <p>Our data indicate that RFA-assisted wedge lung resection in a swine model increases regional MDA and TNF-a factors affecting by this oxidative and pre-inflammatory stress of the procedure. Although RFA-assisted liver resection can be well tolerated in humans, the possible use of this method to the lung has to be further investigated in terms of regional and systemic reactions and the feasibility of performing larger lung resections.</p

Leadership behaviours and healthcare research performance: prospective correlational study

OBJECTIVES: The aims of the study were to determine whether differences in leadership self-perception/behaviour in healthcare researchers may influence research performance and to evaluate whether certain leadership characteristics are associated with enhanced leadership efficiency in terms of motivation, effectiveness and satisfaction. DESIGN AND PARTICIPANTS: All Faculty of Medicine Professors at Imperial College London (n=215) were sent the Multifactor Leadership Questionnaire (MLQ) Self form as a means of evaluating self-perception of leadership behaviours. MAIN OUTCOME MEASURES: For each professor, we extracted objective research performance measures (total number of publications, total number of citations and h index) from 1 January 2007 to 31 December 2009. The MLQ measured three leadership outcomes, which included motivation, effectiveness and satisfaction. Regression analysis was used to determine associations. RESULTS: A total number of 90 responses were received, which equated to a 42% response rate. There were no significant correlations between transformational, transactional or passive/avoidant leadership behaviours and any of the research performance measures. The five transformational leadership behaviours (ie, idealised attributes (IA), idealised behaviours (IB), inspirational motivation (IM), intellectual stimulation (IS), individual consideration (IC)) were highly significant predictors of leadership outcomes, extra effort (all B>0.404, SE=0.093-0.146, p0.359, SE=0.093-0.146, p0.483, SE=0.086-0.139, p<0.001; IB B=0.296, SE=0.101, p=0.004). Similarly, contingent reward was a significant predictor of extra effort (B=0.400, SE=0.123, p=0.002), effectiveness (B=0.353, SE=0.113, p=0.002) and satisfaction (B=0.326, SE=0.114, p=0.005). CONCLUSIONS: This study demonstrates that transformational leadership and contingent reward positively influence leadership efficiency in healthcare researchers. Although we did not show an association between leadership behaviours and research performance metrics, further studies using contextual performance measures at team and organisational levels are required

Management of acute diverticulitis with pericolic free gas (ADIFAS). an international multicenter observational study

Background: There are no specific recommendations regarding the optimal management of this group of patients. The World Society of Emergency Surgery suggested a nonoperative strategy with antibiotic therapy, but this was a weak recommendation. This study aims to identify the optimal management of patients with acute diverticulitis (AD) presenting with pericolic free air with or without pericolic fluid. Methods: A multicenter, prospective, international study of patients diagnosed with AD and pericolic-free air with or without pericolic free fluid at a computed tomography (CT) scan between May 2020 and June 2021 was included. Patients were excluded if they had intra-abdominal distant free air, an abscess, generalized peritonitis, or less than a 1-year follow-up. The primary outcome was the rate of failure of nonoperative management within the index admission. Secondary outcomes included the rate of failure of nonoperative management within the first year and risk factors for failure. Results: A total of 810 patients were recruited across 69 European and South American centers; 744 patients (92%) were treated nonoperatively, and 66 (8%) underwent immediate surgery. Baseline characteristics were similar between groups. Hinchey II-IV on diagnostic imaging was the only independent risk factor for surgical intervention during index admission (odds ratios: 12.5, 95% CI: 2.4-64, P =0.003). Among patients treated nonoperatively, at index admission, 697 (94%) patients were discharged without any complications, 35 (4.7%) required emergency surgery, and 12 (1.6%) percutaneous drainage. Free pericolic fluid on CT scan was associated with a higher risk of failure of nonoperative management (odds ratios: 4.9, 95% CI: 1.2-19.9, P =0.023), with 88% of success compared to 96% without free fluid ( P &lt;0.001). The rate of treatment failure with nonoperative management during the first year of follow-up was 16.5%. Conclusion: Patients with AD presenting with pericolic free gas can be successfully managed nonoperatively in the vast majority of cases. Patients with both free pericolic gas and free pericolic fluid on a CT scan are at a higher risk of failing nonoperative management and require closer observation

Immunohistochemical parameters in the carcinoma of the large bowel, related to the biological behaviour of the tumor

THIS STUDY INTENDED TO FIND, IF THE ALTERED EXPRESSION OF THE ANTI-ONCOGENE P53AND THE OVEREXPRESSION OF THE ONCOGENE C-ERBB-2 IN COLORECTAL CANCER TISSUE CELLS, CORRELATES WITH OTHER VARIABLES KNOWN TO AFFECT THE BIOLOGICAL BEHAVIOUR OF THE TUMOUR AND THE SURVIVAL OF THE PATIENTS. WE APPLIED IMMUNOHISTOCHEMICALTECHNIQUES, USING MONOCLONAL ANTIBODIES IN SECTIONS OF FORMALIN-FIXED, PARAFFIN EMBEDDED TISSUE FROM COLORECTAL CANCER PATIENTS, WHO HAD UNDERGONE A "CURATIVE" RESECTION FOR ADENOCARCINOMA, IN THE 1ST DEPARTMENT OF PROPAEDEUTIC SURGERY ATHENS UNIVERSITY MEDICAL SCHOOL IN 1986. THE P53 EXPRESSION WAS DETECTED SUCCESSFULLY IN 43.75%, WHILE IN THE C-ERBB-2 WAS OVEREXPRESSED IN 28.57% OF THE PATIENTS. P53 IMMUNOREACTIVITY WAS CLEARLY NUCLEAR, WHILE THE C-ERBB-2 EXHIBITS DISTINCT MEMBRANE STAINING. NO CORRELATION WAS PROVED WITH THE STAGE OF THE DISEASE, THE DIFFERENTIATION OF THE NEOPLASM OR OTHER CLINICOPATHOLOGIC FEATURES, SUCH AS THE PRESENCE OF MUCOUS, OR THE NUMBER OF MITOSIS OBSERVED. THE GENERAL SURVIVAL OF THE PATIENTS PROVED TO BE IRRELEVANT WITH THE EXPRESSION STATUS FOR BOTH GENES, AS WAS THE STAGE-RELATED SURVIVAL FOR P53. ON THE OTHER HAND C-ERBB-2 OVEREXPRESSION CORRELATES UNFAVOURABLY WITH THE SURVIVAL OF STAGE C PATIENTS. FINALLY C-ERBB-2 OVEREXPRESSION WAS PROVED TO CORRELATE SIGNIFICANTLY WITH THE P53 ALTERED EXPRESSION IN NEOPLASTIC CELLS.Η ΜΕΛΕΤΗ ΑΥΤΗ ΕΧΕΙ ΣΑΝ ΣΚΟΠΟ ΝΑ ΔΙΕΡΕΥΝΗΣΕΙ ΕΑΝ Η ΑΛΛΑΓΗ ΤΗΣ ΕΚΦΡΑΣΗΣ ΤΟΥ ΑΝΤΙΟΓΚΟΓΟΝΙΔΙΟΥ P53 ΚΑΙ Η ΑΥΞΗΣΗ ΤΗΣ ΕΚΦΡΑΣΗΣ ΤΟΥ ΟΓΚΟΓΟΝΙΔΙΟΥ C-ERBB-2 ΣΤΑ ΚΥΤΤΑΡΑ ΤΟΥ ΑΔΕΝΟΚΑΡΚΙΝΩΜΑΤΟΣ ΤΟΥ ΠΑΧΕΟΣ ΕΝΤΕΡΟΥ ΚΑΙ ΤΟΥ ΟΡΘΟΥ, ΣΥΣΧΕΤΙΖΕΤΑΙ ΩΣ ΑΝΕΞΑΡΤΗΤΟΣ ΠΑΡΑΓΟΝΤΑΣ ΜΕ ΑΛΛΕΣ ΓΝΩΣΤΕΣ ΠΑΡΑΜΕΤΡΟΥΣ, ΠΟΥ ΕΙΝΑΙ ΓΝΩΣΤΟ ΟΤΙ ΣΥΝΔΕΟΝΤΑΙ ΜΕ ΤΗΝ ΠΡΟΓΝΩΣΗ Η ΤΗ ΒΙΟΛΟΓΙΚΗ ΣΥΜΠΕΡΙΦΟΡΑ ΤΟΥ ΝΕΟΠΛΑΣΜΑΤΟΣ ΑΥΤΟΥ. Ο ΠΡΟΣΔΙΟΡΙΣΜΟΣ ΕΓΙΝΕ ΣΕ ΑΣΘΕΝΕΙΣ, ΟΙ ΟΠΟΙΟΙ ΕΠΑΣΧΑΝ ΑΠΟ ΑΔΕΝΟΚΑΡΚΙΝΩΜΑΤΑ ΤΟΥ ΠΑΧΕΟΣ ΕΝΤΕΡΟΥ ΚΑΙ ΥΠΕΒΛΗΘΗΣΑΝ ΣΕ "ΘΕΡΑΠΕΥΤΙΚΗ" ΕΚΤΟΜΗ ΚΑΤΑ ΤΟ ΕΤΟΣ 1986, ΣΤΗΝ Α' ΠΡΟΠΑΙΔΕΥΤΙΚΗ ΧΕΙΡΟΥΡΓΙΚΗ ΚΛΙΝΙΚΗ ΤΟΥ ΠΑΝΕΠΙΣΤΗΜΙΟΥ ΑΘΗΝΩΝ, ΔΙΑ ΤΗΣ ΜΕΘΟΔΟΥ ΤΗΣΑΝΟΣΟΙΣΤΟΧΗΜΙΚΗΣ ΧΡΩΣΗΣ ΜΕ ΜΟΝΟΚΛΩΝΙΚΑ ΑΝΤΙΣΩΜΑΤΑ. ΤΑ ΑΠΟΤΕΛΕΣΜΑΤΑ ΤΗΣ ΠΑΡΟΥΣΑΣ ΜΕΛΕΤΗΣ ΔΕΙΧΝΟΥΝ ΟΤΙ ΓΙΑ ΤΟ ΜΕΝ P53 ΠΑΡΑΤΗΡΗΘΗΚΕ ΑΛΛΑΓΗ ΤΗΣ ΕΚΦΡΑΣΗΣ ΣΤΟ 43,75% ΤΩΝ ΑΣΘΕΝΩΝ, ΕΝΩ ΓΙΑ ΤΟ C-ERBB-2 ΑΥΞΗΜΕΝΗ ΕΚΦΡΑΣΗ ΣΤΟ 28,57% ΤΩΝ ΑΣΘΕΝΩΝ. ΓΙΑ ΤΟ P53 Η ΧΡΩΣΗ ΗΤΑΝ ΣΑΦΩΣ ΠΥΡΗΝΙΚΗ, ΕΝΩ ΓΙΑ ΤΟ C-ERBB-2 ΧΡΩΜΑΤΙΖΕΤΑΙ Η ΚΥΤΤΑΡΟΠΛΑΣΜΑΤΙΚΗ ΜΕΜΒΡΑΝΗ. Η ΔΙΑΦΟΡΟΠΟΙΗΣΗ ΤΟΥ ΝΕΟΠΛΑΣΜΑΤΟΣ, ΤΑ ΣΤΑΔΙΑ ΤΗΣ ΝΟΣΟΥ, ΚΑΘΩΣ ΚΑΙ Ο ΑΡΙΘΜΟΣ ΤΩΝ ΜΙΤΩΣΕΩΝ ΚΑΙ Η ΠΑΡΟΥΣΙΑ ΒΛΕΝΝΗΣ ΣΤΑ ΠΑΡΑΣΚΕΥΑΣΜΑΤΑ,ΣΥΣΧΕΤΙΣΘΗΚΑΝ ΜΕ ΤΙΣ ΔΥΟ ΜΕΤΡΟΥΜΕΝΕΣ ΠΑΡΑΜΕΤΡΟΥΣ, ΧΩΡΙΣ ΝΑ ΔΕΙΧΝΟΥΝ ΣΗΜΑΝΤΙΚΗΣΥΣΧΕΤΙΣΗ. ΤΟ ΙΔΙΟ ΣΥΜΒΑΙΝΕΙ ΚΑΙ ΜΕ ΤΙΣ ΓΕΝΙΚΕΣ ΜΕΣΕΣ ΕΠΙΒΙΩΣΕΙΣ ΤΩΝ ΑΣΘΕΝΩΝ ΟΠΩΣ ΚΑΙ ΓΙΑ ΤΙΣ ΕΠΙΒΙΩΣΕΙΣ ΚΑΤΑ ΣΤΑΔΙΑ ΣΕ ΟΤΙ ΑΦΟΡΑ ΤΟ P53. ΑΝΤΙΘΕΤΩΣ ΟΙ ΑΣΘΕΝΕΙΣ ΣΤΑΔΙΟΥ C ΕΜΦΑΝΙΖΟΥΝ ΣΤΑΤΙΣΤΙΚΑ ΛΙΑΝ ΣΗΜΑΝΤΙΚΗ ΚΑΛΥΤΕΡΗ ΕΠΙΒΙΩΣΗ ΟΤΑΝ ΔΕΝΕΚΦΡΑΖΟΥΝ ΣΕ ΑΥΞΗΜΕΝΟ ΒΑΘΜΟ ΤΟ C-ERBB-2. ΤΕΛΟΣ, Η ΣΥΝΥΠΑΡΞΗ ΤΩΝ ΔΥΟ ΓΟΝΙΔΙΩΝ (ΑΛΛΑΓΗ ΕΚΦΡΑΣΗΣ ΤΟΥ P53 ΚΑΙ ΑΥΞΗΣΗ ΤΗΣ ΕΚΦΡΑΣΗΣ ΤΟΥ C-ERBB-2) ΣΥΣΧΕΤΙΖΕΤΑΙ ΣΕΒΑΘΜΟ ΣΤΑΤΙΣΤΙΚΑ ΣΗΜΑΝΤΙΚΟ