Complications in lymph node excision in the head and neck area

Background Although needle biopsy is widely used in work-up of lymphadenopathy, lymph node excision (LNE) is often required especially in lymphoma diagnostics. LNE is an invasive procedure, which carries a potential risk of complications. However, comprehensive studies evaluating the spectrum and occurrence of complications are lacking. Aims/Objectives This study addresses the role of preoperative needle biopsies in patients who underwent LNE. Furthermore, surgical complications related to LNE are analyzed. Materials and methods Altogether 321 patients, who underwent LNE in two-year period in 2018-19, and fulfilled our study criteria, were included. Patients' data were retrieved from the electronic patient records. Results The surgical complication rate was 5.9%. Most of the complications (n = 16; 84.2%) were categorized as minor (I-II) according to the Clavien-Dindo scale. The remaining three (15.8%), all hemorrhages, were categorized as major complications and required intervention. Preoperative needle biopsy might have avoided the need for LNE in some patients, which we discuss in this study. Conclusions and significance Surgical complications after LNE in the head and neck area are rare and mostly minor. Needle biopsy is often recommended preoperatively to avoid unnecessary operations and to refrain performing LNE for patients with non-lymphatic malignancy.Peer reviewe

Isolation precautions cause minor delays in diagnostics and treatment of non-COVID patients

Publisher Copyright: © 2021Background: Isolation precautions are essential prevent spread of COVID-19 infection but may have a negative impact on inpatient care. The impact of these measures on non-COVID-19 patients remains largely unexplored. Aim: This study aimed to investigate diagnostic and treatment delays related to isolation precautions, the associated patient outcome, and the predisposing risk factors for delays. Methods: This observational study was conducted in seven Helsinki region hospitals during the first wave of the COVID-19 pandemic in Finland. The study used data on all non-COVID-19 inpatients, who were initially isolated due to suspected COVID-19, to estimate whether isolation precautions resulted in diagnostic or treatment delays. Results: Out of 683 non-COVID-19 patients, 33 (4.8%) had delays related to isolation precautions. Clinical condition deteriorated non-fatally in seven (1.0%) patients. The following events were associated with an increased risk of treatment or a diagnostic delay: more than three ward transfers (P = 0.025); referral to an incorrect speciality in the emergency department (P = 0.004); more than three SARS-CoV-2 RT-PCR tests performed (P = 0.022); and where cancer was the final diagnosis (P = 0.018). In contrast, lower respiratory tract symptoms (P = 0.013) decreased the risk. Conclusions: The use of isolation precautions for patients who did not have COVID-19 had minor negative effects on patient outcomes. The present study underlines the importance of targeting diagnostic efforts to patients with unspecified symptoms and to those with a negative SARS-CoV-2 test result. Thorough investigations to achieve an accurate diagnosis improves the prognosis of patients and facilitates appropriate targeting of hospital resources.Peer reviewe

Unmanned aircraft system (UAS) structure-from-motion (SfM) for monitoring the changed flow paths and wetness in minerotrophic peatland restoration

Abstract Peatland restoration aims to achieve pristine water pathway conditions to recover dispersed wetness, water quality, biodiversity and carbon sequestration. Restoration monitoring needs new methods for understanding the spatial effects of restoration in peatlands. We introduce an approach using high-resolution data produced with an unmanned aircraft system (UAS) and supported by the available light detection and ranging (LiDAR) data to reveal the hydrological impacts of elevation changes in peatlands due to restoration. The impacts were assessed by analyzing flow accumulation and the SAGA Wetness Index (SWI). UAS campaigns were implemented at two boreal minerotrophic peatland sites in degraded and restored states. Simultaneously, the control campaigns mapped pristine sites to reveal the method sensitivity of external factors. The results revealed that the data accuracy is sufficient for describing the primary elevation changes caused by excavation. The cell-wise root mean square error in elevation was on average 48 mm when two pristine UAS campaigns were compared with each other, and 98 mm when each UAS campaign was compared with the LiDAR data. Furthermore, spatial patterns of more subtle peat swelling and subsidence were found. The restorations were assessed as successful, as dispersing the flows increased the mean wetness by 2.9–6.9%, while the absolute changes at the pristine sites were 0.4–2.4%. The wetness also became more evenly distributed as the standard deviation decreased by 13–15% (a 3.1–3.6% change for pristine). The total length of the main flow routes increased by 25–37% (a 3.1–8.1% change for pristine), representing the increased dispersion and convolution of flow. The validity of the method was supported by the field-determined soil water content (SWC), which showed a statistically significant correlation (R² = 0.26–0.42) for the restoration sites but not for the control sites, possibly due to their upslope catchment areas being too small. Despite the uncertainties related to the heterogenic soil properties and complex groundwater interactions, we conclude the method to have potential for estimating changed flow paths and wetness following peatland restoration