Correlation of Hamstring Tendon Size in Pre-Operative MRI Measurement with Intra-Operative Graft Size in Primary Anterior Cruciate Ligament (ACL) Reconstruction

Background: The size of Hamstring autograft of less than 8.0 mm in ACL re-construction is one of the key factors that may contribute to the failure of the graft. In this study, we are going to assess the correlation of pre-operative MRI measurement of Hamstring tendons with the intra-operative ACL graft. Thus, it may help surgeons to anticipate the needs for graft augmentation should the final graft size be smaller than expected. Methods: We retrospectively re-viewed 41 cases of ACL reconstructions in which MRI were done pre-operatively, in Hospital Pakar Sultanah Fatimah (HPSF), Muar between January 2019 until December 2022. MRI measurements of Hamstring tendon (semitendinosus: ST, and gracilis) were done by a radiologist, and the in-tra-operative notes were reviewed for the final graft size. Pearson’s correlation coefficients were calculated to determine the relationship between graft size and tendon cross-sectional area. The intraclass correlation (ICC) by using two-way mixed model with type consistency, the reliability based on average measure was 0.41 (95% CI: ?0.10, 0.69). A p-value < 0.05 was considered sig-nificant. Results: Of 105 patients with primary ACL reconstruction done be-tween January 2019 to December 2022, only 41 patients were included in this study. There was fair correlation (p = 0.048) between pre-operative MRI measurement and the graft diameter intra-operatively. The mean of 17.0 mm of combined diameter of ST and gracilis tendon in MRI may results in graft diameter of 8.3 mm. There was also positive correlation between patients’ height and the intra-operative graft size. Conclusion: These results showed good correlation between pre-operative MRI measurement of Hamstring ten-don size with the intra-operative graft size, hence it is a reliable tool to predict the Hamstring autograft size in ACL reconstruction.

Hypo-Calories with Micronutrients and Fat Emulsion of Pre-Operative Peripheral Parenteral Nutrition in Malnutrition Risk Rectal Cancer Patients: A Retrospective Cross-Sectional Study

Malnutrition has been recognized as a significant risk factor for the post operated patients, especially for those patients undergoing abdominal operations. This study evaluated the effect of hypo-calories with micronutrients of pre-operative peripheral parenteral nutrition support (PPPN) for rectal cancer patients. Retrospective cross sectional study method was used to investigate. We screened rectal cancer patients past year pre-operative with malnutrition risk from our cancer database and divided into 2 groups, received or not received PPPN and compared the post-operative outcomes. The results showed that the post-operative serum albumin of the 25 patients received PPPN averaged 2.5 ± 0.32 g/dl;significantly better than those of the 15 patients not received PPPN (non-PPPN), which averaged 1.92 ± 0.42 g/dl. The first ambulatory time required 3.0 ± 0.8 days for the PPPN, significantly shorter than those for the non-PPPN, which averaged 4.9 ± 2.4 days. Post-operative hospital days for the patients received PPPN were 18.2 ± 10.5 day, also significantly fewer than the non-PPPN, which averaged 33.7 ± 20.0 day. More than 25% of the non-PPPN was infected with sepsis, while none was infected in the PPPN patients. In conclusion, this study verified the benefits of micronutrients of pre-operative peripheral parenteral nutrition support for rectal cancer patients.

Effective Communication in the Pre-Operative Environment

Introduction: Building a strong patient rapport is a founding principle instilled early on in medical education. For many specialties, this relationship can be developed through repeated encounters. However, anesthesiologists are limited in opportunity for which such rapport can be built. Therefore, it is critical that the pre-operative visit is used effectively to develop a strong patient-physician relationship and help relieve patient anxiety. Methods: The primary objective of this study was to determine what communication aspects are most important to patients in the pre-operative period. Secondary objectives were to evaluate the effectiveness of our current communication practices and their impact on patient’s anxiety. This study was an anonymous and voluntary survey conducted in the pre-operative area prior to elective surgical cases at Mayo Clinic Arizona from Dec. 2018-Jan. 2019. Patients completed a one-page questionnaire ranking the importance of various communication aspects and its subsequent impact on their anxiety level. Results: Of the communication qualities evaluated, patients most valued their physician’s thoroughness and ability to describe their anesthetic plan. Greater than 95% of patients felt “very satisfied” with their anesthesia provider encounter and on a 1 - 5 point scale, with 5 being the highest, there was an average reduction of 0.75 in anxiety level after completion of the anesthesia interview. Conclusion: Incorporation of and improving these communication aspects during your pre-operative evaluation can help improve rapport, reduce patient anxiety, and improve the patient’s overall experience. Implementing a communication-focused curriculum during training may prove beneficial in improving resident’s effectiveness in communicating.

Pre-Operative Hyponatremia in a High Dependency Cardiovascular Surgical Center of a Tertiary Health Facility in Nigeria: Risk Factors, Prevalence, Clinical Correlates and Treatment Outcome. A Retrospective Cohort Study

Introduction: Hyponatremia is the commonest electrolyte derangement seen in medical and surgical wards and in high dependency treatment units. It is associated with prolonged hospital stay, high economic burden and increased morbidity and mortality. Hyponatremia is well reported in medical and surgical conditions but literature is scanty concerning its relationship with treatment outcome in patients managed in high dependency heart and vascular surgical centers. Objectives: To determine the prevalence, determinants, clinical correlates and outcome of pre-operative hyponatremia. Methods: Retrospective study involving patients that had surgery (cardiac and vascular) between January 2015 and December 2019. Data were obtained from patients’ case files, perioperative and intensive unit charts. All participants with preoperative hyponatremia had their serum sodium corrected to ≥135 mmol before surgical incision and those with hypernatremia had their sodium corrected to <145 mmol. The socio-demographic, clinical, laboratory findings were entered. Statistical analysis was done using student’s t-test and Chi square. Results: Of the 305 participants (186 males and 119 females), pre-operative hyponatremia was found in 30.8% and normonatremia in 59.7%. Pre-operative hyponatremia was more common in advance age, overweight, those presenting for open heart and other major surgeries and those with background chronic heart failure and chronic liver disease. Participants with pre-operative hyponatremia had shortened and also prolonged hospital stay and higher risk of death than with normonatremia. Conclusion: Pre-operative hyponatremia is common in high dependency surgical unit particularly in the elderly, those with comorbidities and those presenting for major heart surgeries. It impacts negatively on the morbidity and mortality as it could shorten hospital stay through death, and could prolong hospital stay with increased health burden on patients, their care givers and the general population. The impact of this finding across different races needs further evaluation.

Transcutaneous acupoint electrical stimulation(TAES)for pre-operative anxiety:a prospective observational pilot investigation

Objective:Transcutaneous acupoint electrical stimulation(TAES)treatment is effective for post-operative anxiety.The investigation was designed to study the feasibility and effectiveness of TAES treatment for pre-operative anxiety.Methods:62 volunteered surgical patients were included in the pilot investigation.They all received TAES treatment for 30 minutes in the evening of the day before operation.Hegu(LI4)and Neiguan(PC6)of both sides were selected as the treatment acupoints.The anxiety degrees were measured by State-Trait Anxiety Inventory.Heart rate and blood pressure were also recorded.Results:After TAES,pre-operative anxiety measured by State-Trait Anxiety Inventory dropped by almost 12%,and both heart rate and systolic blood pressure decreased significantly.Conclusion:The pilot investigation of TAES for pre-operative anxiety can successfully test the feasibility of outcome measurements and provide necessary data for calculating the sample size of a subsequent randomized controlled trial.

Correlation study between pre-operative platelet aggregation rate and peri-operative blood product application in patients with off-pump coronary artery bypass grafting

Objective To explore the impact of pre-operative platelet aggregation rate(PAR)on off-pump coronary artery bypass grafting(OPCABG),meanwhile to study the relationship between platelet function and blood product application during peri-operative period in relevant patients.Methods A total of 172 patients receiving OPCABG in our hospita from 2014-01 to 2015-09 were en-

Role of artificial intelligence in colorectal cancer

The sphere of artificial intelligence(AI)is ever expanding.Applications for clinical practice have been emerging over recent years.Although its uptake has been most prominent in endoscopy,this represents only one aspect of holistic patient care.There are a multitude of other potential avenues in which gastrointestinal care may be involved.We aim to review the role of AI in colorectal cancer as a whole.We performed broad scoping and focused searches of the applications of AI in the field of colorectal cancer.All trials including qualitative research were included from the year 2000 onwards.Studies were grouped into pre-operative,intra-operative and post-operative aspects.Preoperatively,the major use is with endoscopic recognition.Colonoscopy has embraced the use for human derived classifications such as Narrow-band Imaging International Colorectal Endoscopic,Japan Narrow-band Imaging Expert Team,Paris and Kudo.However,novel detection and diagnostic methods have arisen from advances in AI classification.Intra-operatively,adjuncts such as image enhanced identification of structures and assessment of perfusion have led to improvements in clinical outcomes.Post-operatively,monitoring and surveillance have taken strides with potential socioeconomic and environmental savings.The uses of AI within the umbrella of colorectal surgery are multiple.We have identified existing technologies which are already augmenting cancer care.The future applications are exciting and could at least match,if not surpass human standards.

Disposable circumcision suture device： clinical effect and patient satisfaction

In our experience patients undergoing circumcision are mostly concerned about pain and penile appearances. We conducted a prospective randomized trial to assess the benefits of a new disposable circumcision suture device （DCSD）. A total of 942 patients were equally divided into three groups （conventional circumcision, Shang ring and disposable suture device group）. Patients in the DCSD group were anesthetized with compound 5% lidocaine cream, the others with a 2% lidocaine penile block. Operation time, intra-operative blood loss, incision healing time, intra-operative and post-operative pain, the penile appearance and overall satisfaction degree were measured. Operation time and intra-operative blood loss were significantly lower in the Shang ring and suture device groups compared to the conventional group （P 〈 0.001）. Intra-operative pain was less in the suture device group compared With the other two groups （P 〈 0.001）; whereas post-operative pain was higher in the conventional group compared to the other two groups （P 〈 0.001）. Patients in the suture device （80.57%） and Shang ring （73,57%） groups were more satisfied with penile appearances compared with the conventional circumcision group （20.06%, P 〈 0.05）. Patients in suture device group also healed markedly faster than the conventional group （P 〈 0.01）. The overall satisfaction rate was better in the suture device group （78.66%） compared with the conventional （47.13%） and Shang ring （50.00%） groups （P 〈 0.05）. The combination of DCSD and lidocaine cream resulted in shorter operation and incision healing times, reduced intra-operative and post-operative pain and improved patient satisfaction with the cosmetic appearances.

Bariatric surgery and long-term nutritional issues

Bariatric surgery is recognized as a highly effective therapy for obesity since it accomplishes sustained weight loss, reduction of obesity-related comorbidities and mortality, and improvement of quality of life. Overall, bariatric surgery is associated with a 42% reduction of the cardiovascular risk and 30% reduction of all-cause mortality. This review focuses on some nutritional consequences that can occur in bariatric patients that could potentially hinder the clinical benefits of this therapeutic option. All bariatric procedures, to variable degrees, alter the anatomy and physiology of the gastrointestinal tract; this alteration makes these patients more susceptible to developing nutritional complications, namely, deficiencies of macro-and micro-nutrients, which could lead to disabling diseases such as anemia, osteoporosis, protein malnutrition. Of note is the evidence that most obese patients present a number of nutritional deficits already prior to surgery, the most important being vitamin D and iron deficiencies. This finding prompts the need for a complete nutritional assessment and, eventually, an adequate correction of pre-existing deficits before surgery. Another critical issue that follows bariatric surgery is post-operative weight regain, which is commonly associated with the relapse of obesity-related comorbidities. Nu-tritional complications associated with bariatric surgery can be prevented by life-long nutritional monitoring with the administration of multivitamins and mineral supplements according to the patient's needs.

Enhanced recovery after surgery strategy to shorten perioperative fasting in children undergoing non-gastrointestinal surgery:A prospective study

BACKGROUND Enhanced recovery after surgery strategies are increasingly implemented to improve the management of surgical patients.AIM To evaluate the effects of new perioperative fasting protocols in children≥3 mo of age undergoing non-gastrointestinal surgery.METHODS This prospective pilot study included children≥3 mo of age undergoing nongastrointestinal surgery at the Children’s Hospital(Zhejiang University School of Medicine)from January 2020 to June 2020.The children were divided into either a conventional group or an ERAS group according to whether they had been enrolled before or after the implementation of the new perioperative fasting strategy.The children in the conventional group were fasted using conventional strategies,while those in the ERAS group were given individualized fasting protocols preoperatively(6-h fasting for infant formula/non-human milk/solids,4-h fasting for breast milk,and clear fluids allowed within 2 h of surgery)and postoperatively(food permitted from 1 h after surgery).Pre-operative and postoperative fasting times,pre-operative blood glucose,the incidence of postoperative thirst and hunger,the incidence of perioperative vomiting and aspiration,and the degree of satisfaction were evaluated.RESULTS The study included 303 patients(151 in the conventional group and 152 in the ERAS group).Compared with the conventional group,the ERAS group had a shorter pre-operative food fasting time[11.92(4.00,19.33)vs 13.00(6.00,20.28)h,P<0.001],shorter preoperative liquid fasting time[3.00(2.00,7.50)vs 12.00(3.00,20.28)h,P<0.001],higher preoperative blood glucose level[5.6(4.2,8.2)vs 5.1(4.0,7.4)mmol/L,P<0.001],lower incidence of thirst(74.5%vs 15.3%,P<0.001),shorter time to postoperative feeding[1.17(0.33,6.83)vs 6.00(5.40,9.20),P<0.001],and greater satisfaction[7(0,10)vs 8(5,10),P<0.001].No children experienced perioperative aspiration.The incidences of hunger,perioperative vomiting,and fever were not significantly different between the two groups.CONCLUSION Optimizing fasting and clear fluid drinking before non-gastrointestinal surgery in children≥3 mo of age is possible.It is safe and feasible to start early eating after evaluating the recovery from anesthesia and the swallowing function.

Fine needle aspiration diagnosis of isolated pancreatic tuberculosis: A case report

Tuberculosis(TB) involving the pancreas are uncommon, especially when present in immunocompetent hosts. Pancreatic TB is more frequently associated with miliary TB or widely disseminated disease. Pancreatic TB may present as cystic or solid pancreatic masses, pancreatic abscess or acute or chronic pancreatitis. Majority of the cases are diagnosed after surgical exploration for presumed pancreatic malignancy and preoperative diagnosis is quite difficult. However, improvement in imaging techniques and the resulting imageguided interventions gradually can obviate the need for more invasive diagnostic surgical procedures and expedite the planning of therapy. Herein, we report a rare case of isolated pancreatic TB which presented with pancreatic mass lesion in an immunocompetent host. Diagnosis was made by contrast enhanced computed tomography and guided fine needle aspiration of the pancreatic mass which revealed acid-fast bacillion Ziehl-Neelsen stain. The case was treated successfully with antituberculous drugs. Pancreatic tuberculosis should be considered in the differential diagnosis of a pancreatic mass when the patient is young, residing in the endemic zone of tuberculosis. Every attempt should be made to diagnose the cases to prevent unnecessary operation.

Exercise manual for liver disease patients

AIM: To increase inspiratory muscle strength and improve the quality of life of candidates for liver transplantation.METHODS: Twenty-three candidates for liver transplantation participated in the control group and 14 made up the intervention group. The control group consisted of 18 men and 5 women, body mass index(BMI) 27.3 ± 4.5 kg/m2 and Model for End-Stage Liver Disease(MELD) 18.2 ± 6.1. The intervention group consisted of 11 men and 3 women, BMI 28.6 ± 5.4 kg/m2 and MELD 18 ± 4.5. The presence or absence of ascites was identified in the first patient evaluation and after three months. We evaluated maximal inspiratory pressure(MIP) and maximal expiratory pressure, spirometry, root mean square(RMS) of diaphragm and rectus abdominis, and the quality of life. The exercises were performed daily by patients at home for three months and were supervised at distance monthly. The manual consisted of diaphragmatic breathing exercises, diaphragmatic isometric exercise, Threshold IMT&#174;, lifting upper limbs with a bat and strengthening the abdomen. RESULTS: There was significant difference(P = 0.01) between the first(initial) and the third month(final) MIP in the control group and in the intervention group, but there was no difference(P = 0.45) between the groups.The RMS of the diaphragm was lower(P = 0.001) and the functional capacity was higher(P = 0.006) in the intervention group compared to the control. The general health and mental health domains received higher scores after three months in the control group(P = 0.01) and the intervention group(P = 0.004), but there was no significant difference between them. The comparison between the presence of initial ascites with the presence of ascites was performed after three months in the control group(P = 0.083) and intervention group(P = 0.31). There was no significant difference, in relation to the presence of ascites after three months between groups(P = 0.21). In the intervention group, patients with ascites at the end of the time period had decreased scores on the social aspects SF-36 domain(P = 0.023) compared to those who had no ascites. CONCLUSION: The proposed exercises provide an increase in the inspiratory muscle strength and improve functional capacity, consequently bettering the quality of life of liver disease patients.

Preoperative physiological esophageal assessment for anti-reflux surgery:A guide for surgeons on high-resolution manometry and pH testing

Gastroesophageal reflux disease (GERD) is one of the most commonlyencountered digestive diseases in the world, with the prevalence continuing toincrease. Many patients are successfully treated with lifestyle modifications andproton pump inhibitor therapy, but a subset of patients require more aggressiveintervention for control of their symptoms. Surgical treatment with fundoplicationis a viable option for patients with GERD, as it attempts to improve the integrityof the lower esophageal sphincter (LES). While surgery can be as effective asmedical treatment, it can also be associated with side effects such as dysphagia,bloating, and abdominal pain. Therefore, a thorough pre-operative assessment iscrucial to select appropriate surgical candidates. Newer technologies arebecoming increasingly available to help clinicians identify patients with true LESdysfunction, such as pH-impedance studies and high-resolution manometry(HRM). Pre-operative evaluation should be aimed at confirming the diagnosis ofGERD, ruling out any major motility disorders, and selecting appropriate surgicalcandidates. HRM and pH testing are key tests to consider for patients with GERDlike symptoms, and the addition of provocative measures such as straight legraises and multiple rapid swallows to HRM protocol can assess the presence ofunderlying hiatal hernias and to test a patient’s peristaltic reserve prior tosurgery.

Prediction of overall survival following colorectal cancer surgery in elderly patients

BACKGROUND With advanced age and chronic illness,the life expectancy of a patient with colorectal cancer(CRC)becomes less dependent on the malignant disease and more on their pre-morbid condition.Justifying major surgery for these elderly patients can be challenging.An accurate tool demonstrating post-operative survival probability would be useful for surgeons and their patients.AIM To integrate clinically significant prognostic factors relevant to elective colorectal surgery in the elderly into a validated pre-operative scoring system.METHODS In this retrospective cohort study,patients aged 70 and above who underwent surgery for CRC at Singapore General Hospital between 1 January 2005 and 31 December 2012 were identified from a prospectively maintained database.Patients with evidence of metastatic disease,and those who underwent emergency surgery or had surgery for benign colorectal conditions were excluded from the analysis.The primary outcome was overall 3-year overall survival(OS)following surgery.A multivariate model predicting survival was derived and validated against an equivalent external surgical cohort from Kyungpook National University Chilgok Hospital,South Korea.Statistical analyses were performed using Stata/MP Version 15.1.RESULTS A total of 1267 patients were identified for analysis.The median post-operative length of stay was 8[interquartile range(IQR)6-12]d and median follow-up duration was 47(IQR 19-75)mo.Median OS was 78(IQR 65-85)mo.Following multivariate analysis,the factors significant for predicting overall mortality were serum albumin<35 g/dL,serum carcinoembryonic antigen≥20μg/L,T stage 3 or 4,moderate tumor cell differentiation or worse,mucinous histology,rectal tumors,and pre-existing chronic obstructive lung disease.Advanced age alone was not found to be significant.The Korean cohort consisted of 910 patients.The Singapore cohort exhibited a poorer OS,likely due to a higher proportion of advanced cancers.Despite the clinicopathologic differences,there was successful validation of the model following recalibration.An interactive online calculator was designed to facilitate post-operative survival prediction,available at http://bit.ly/sgh_crc.The main limitation of the study was selection bias,as patients who had undergone surgery would have tended to be physiologically fitter.CONCLUSION This novel scoring system generates an individualized survival probability following colorectal resection and can assist in the decision-making process.Validation with an external population strengthens the generalizability of this model.

Pathological humerus fracture due to anti-interferon-gamma autoantibodies:A case report

BACKGROUND Various etiologies contribute to pathological fractures,including bone infections.Recently,non-tuberculosis Mycobacterium-related bone infections among patients with anti-interferon-gamma autoantibody-induced adult-onset immunodeficiency has raised concerns in Southeast Asia,with the common presentations including osteomyelitis.However,it also rarely manifests as traumatic fractures,as reported in this case.CASE SUMMARY A diabetic female fractured her humerus after a traumatic accident and received fixation surgery.Abnormal necrotic bone tissue and abscess formation were noted,and she was diagnosed with a pathological fracture due to nontuberculosis Mycobacterium infection.Multiple bone involvement was also revealed in a bone scan.Anti-interferon-gamma autoantibodies were then checked due to an unexplained immunocompromised status and found to be positive.Her humerus fracture and multiple bone infections healed after steroid and anti-non-tuberculosis Mycobacterium medication treatment following fixation surgery.CONCLUSION Comprehensive preoperative evaluations may help identify pathological fractures and guide the treatment course.

Platelets Levels before and after Surgical Intervention in Patients with Oral and Maxillofacial Tumors at MNH, Tanzania

Background: There are documented effects of platelets on the solid tumors which need further study. The elevated platelet counts have been described for majority of cancers. There is inadequate information of effect of benign and malignant oral and maxillofacial tumors on the regulation of platelets. The aim of this study was to investigate the changes in platelet counts among patients with oral and maxillofacial benign and malignant tumors following surgical interventions. Methods: A descriptive postoperative study was done whereby patients with benign and malignant oral and maxillofacial tumors who met the inclusion criteria were included. The included patients were those who had no history of blood transfusion prior, during or after surgery, not on haemoglobin-boosting or bone marrow suppressing medications, not seropositive to human immunodeficiency virus also without clinical findings suggestive of lymphadenopathy, splenomegaly, ecchymosis and petechiae. Demographic data, Platelet counts and haemoglobin levels before and after surgery were documented and analysed by chi-square test and values were considered to be significant if p < 0.05. Results: A total of 61 patients were included in the study. The mean age of participants was 37.03 ± 16.6 years with range of 7 to 77 years. Majority 82.5% (n = 52) had benign tumors with a leading diagnosis of ameloblastoma followed by ossifying fibroma. In general there was an increase of platelet counts following surgery from the mean of 276.38 ± 109.40 K/uL to 308.51 ± 117.24 K/uL. Looking at benign and malignant separately, following surgery there was an increase of platelet counts for benign tumors (278.87 ± 106.37 to 305.96 ± 123.12) but a decrease for malignant tumors group (282.33 ± 147.03 to 232 ± 78.48). The haemoglobin level changed from the mean of 12.60 ± 1.71 g/dl before surgery to 11.69 ± 1.70 g/dl after surgery. Conclusion: The mean postoperative increase in platelet counts in benign and malignant tumors was due to healing process of the wound following surgery while the postoperative decrease in platelets counts in malignant tumors was due to effect of tumor removal which diminished the production of platelets activating factors. Malignant tumors produce platelets activating factors which are necessary for them to grow. Also, the difference in postoperative platelets counts in benign and malignant oral and maxillofacial tumors could be attributed by different biological behavior of benign and malignant tumors and hence different interactions of platelets to these tumors.

Proximal and distal rectal cancers differ in curative resectability and local recurrence

AIM: To evaluate patients with proximal rectal cancer (PRC) (> 6 cm up to 12 cm) and distal rectal cancer (DRC) (0 to 6 cm from the anal verge). METHODS: Two hundred and eighteen patients (120 male, 98 female, median age 58 years, range 19-88 years) comprised 100 with PRC and 118 with DRC. The proportion of T1, T2 vs T3, T4 stage cancers was similar in both groups (PRC: T1+T2 = 29%; T3+T4 = 71% and DRC: T1+T2 = -31%; T3+T4 = 69%). All patients had cancer confined to the rectum -those with synchronous distant metastasis were excluded. Surgical resection was with curative intent with or without pre-operative chemoradiation (c-RT). Follow-up was for a median of 35 mo (range: 12 to 126 mo). End points were: 30 d mortality, complications of operation, microscopic tumour-free margins, resection with a tumour-free circumferential margin (CRM) of 1 to 2 mm and > 2 mm, local recurrence, survival and the permanent stoma rate. RESULTS: Overall 30-d mortality was 6% (12): PRC 7 % and DRC 4%. Postoperative complications occurred in 14% with PRC compared with 21.5% with DRC, urinary retention was the complication most frequently reported (PRC 2% vs DRC 9%, P = 0.04). Twelve percent with PRC compared with 37% with DRC were subjected to preoperative c-RT (P = 0.03). A tumour-free CRM of 1 to 2 mm and > 2 mm was reported in 93% and 82% with PRC and 88% and 75% with DRC respectively (PRC vs DRC, P > 0.05). However, local recurrence was 5% for PRC vs 11% for DRC (P < 0.001). Three and five years survival was 65.6% and 60.2% for PRC vs 67% and 64.3% for DRC respectively. No patient with PRC and 23 (20%) with DRC received an abdomino-perineal resection. CONCLUSION: PRC and DRC differ in the rate of abdomino-perineal resection, post-operative urinary retention and local recurrence. Survival in both groups was similar.

Preoperative embolization of skull-base tumors: Indications, utility, and concerns

Skull-base tumors are generally difficult to access compared with many other cranial lesions. Usually surgery remains the gold standard treatment for the majority of these tumors. However, in many cases, surgical resection is a challenge because the disease usually is already in the advanced stage by the time of diagnosis. Additionally, there are hypervascular lesions which cause excessive loss of blood, then results in multiple blood transfusions and prolonged operative time, increases the risk of neural injury and prevents complete excision. In order to reduce blood loss intraoperatively, many alternatives were available with the neurosurgical armamentarium, such as head elevation, intravenous use of tranexamic acid, total intravenous anesthesia and even preoperative embolization of tumors. However, preoperative embolization carries variable results, potentially aggravating edema and increasing tumor size. To ascertain the current status and the up-to-date indications, an evaluation of the therapeutic role of preoperative embolization was performed in the current study.

Bacteriolgy before and after total middle ear reconstruction

Objectives To investigate pre-and post-total middle ear reconstruction bacteriological changes in order to facilitate prevention and treatment of surgical infections. Methods Specimens from 128 ears in 124 patients with problematic mastoid cavities who underwent revision total middle ear reconstruction were studied. Results Bacteriological tests were positive in 87(68.0%) pre-operative specimens, despite local treatment, and in 74 (57.8%) specimens collected 10 days after operation. Common organism strains in pre-and post-operative specimens were slightly different and included: coagulase-staphylococcus, GRAM+ rods, staphylococcus aureus, pseudomonas aeruginosa and fungi. At the time of patient discharge(15-20 days post-operative), only 3 ears (2.3%) were tested positive which responded well to and became dry after local treatment. At one year, 4 ears (3.1%) showed recurrent otorrhea which again responded to local treatment. Conclusion For infection of problematic mastoid cavities after an open cavity procedure, revision total middle ear reconstruction is effective in controlling infection and promoting a dry ear. Infection prevention and treatment is important considering the relatively high rates of peri-operative local infections.

Obstructive Sleep Apnea and Post-Operative Complications: Single Center Data, Review of Literature and Guidelines for Practicing Internists and Surgeons

Obstructive sleep apnea has been linked to higher rates of post-operative complications in some studies. We examined the prevalence of obstructive sleep apnea and its impact on post-operative complications in 125 patients (21 prospective, 104 retrospective) undergoing various elective outpatient surgeries at our institution. Ten percent of these patients had OSA, and half of them were on continuous positive airway pressure therapy (CPAP). Patients who were on CPAP as outpatients received CPAP post-operatively as well. No patients died, and the prevalence of post-operative complications was low. There was no difference in complication rates between patients with and without OSA. We also review the existing literature on this subject and make practical recommendations regarding pre-operative evaluation and post-operative management of these patients for practicing internists and surgeons based on the current literature.