The Effects of Surgical Exploration on Survival of Unresectable Pancreatic Carcinoma:A Retrospective Case-Control Study

Background: Surgery may trigger the release of inflammatory factors, including cytokines, growth factors and angiogenic factors, which may stimulate tumor growth and progression. The present study was undertaken to evaluate the impact of surgical exploration on survival of patients with potentially resectable pancreatic cancer, who intraoperatively were found to have unresectable disease. Methods: Patients with pancreatic adenocarcinoma undergoing surgical exploration, without tumor resection, at our institution between 2009 and 2014, were selected and case-matched to patients who underwent primary palliative treatment. Results: A total of 116 patients were included. The surgical exploration group (n = 29) had significantly lower CRP levels at the time of diagnosis compared to the palliative controls (n = 87), 4 mg/L vs 12 mg/L;p = 0.004. The percentage of patients who received palliative chemotherapy was comparable between groups, but the time until start of chemotherapy was significantly longer in the surgical exploration group, 2 months vs 1 months;p Conclusion: In this case-control study, we could not detect any survival disadvantage due to surgical exploration in the setting of unresectable pancreatic cancer. Surgical exploration was associated with delayed start of palliative chemotherapy, but the percentage of patients who ultimately received chemotherapy was comparable to patients undergoing primary palliative treatment.

Timing of surgical operation for patients with intra-abdominal infection:A systematic review and meta-analysis

BACKGROUND Intra-abdominal infections(IAIs)is the most common type of surgical infection,with high associated morbidity and mortality rates.In recent years,due to the use of antibiotics,various drug-resistant bacteria have emerged,making the treatment of abdominal infections more challenging.Early surgical exploration can reduce the mortality of patients with abdominal infection and the occurrence of complications.However,available evidence regarding the optimal timing of IAI surgery is still weak.In study,we compared the effects of operation time on patients with abdominal cavity infection and tried to confirm the best timing of surgery.AIM To assess the efficacy of early vs delayed surgical exploration in the treatment of IAI,in terms of overall mortality.METHODS A systematic literature search was performed using PubMed,EMBASE,Cochrane Central Register of Controlled Trials,Ovid,and ScienceDirect.The systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses method.Based on the timing of the surgical operation,we divided the literature into two groups:Early surgery and delayed surgery.For the early and delayed surgery groups,the intervention was performed with and after 12 h of the initial surgical intervention,respectively.The main outcome measure was the mortality rate.The literature search was performed from May 5 to 20,2021.We also searched the World Health Organization International Clinical Trials Registry Platform search portal and ClinicalTrials.gov on May 20,2021,for ongoing trials.This study was registered with the International Prospective Register of Systematic Reviews.RESULTS We identified nine eligible trial comparisons.Early surgical exploration of patients with IAIs(performed within 12 h)has significantly reduced the mortality and complications of patients,improved the survival rate,and shortened the hospital stay.CONCLUSION Early surgical exploration within 12 h may be more effective for the treatment of IAIs relative to a delayed operation.

Open Scrotal Trauma Complicated by Testicular Evisceration: An Unusual Injury after a Brawl in 2 Cases

Background: Scrotal trauma is a rare injury, and can compromise reproductive function. If in closed trauma, a morphological assessment of the lesion is usually necessary before treatment, in open trauma otherwise, namely in the case of testicular evisceration, surgical exploration is the rule. Objective: To present the management of open scrotal trauma. Case Presentation: These were two adults aged 42 and 63, admitted for post-traumatic testicular evisceration. One of the patients presented with signs of infection due to a diagnosis delay. Management consisted on surgical exploration, with scrotal debridement and testicular reintegration. The evolution was favourable. Conclusion: Open scrotal trauma is a rare lesion that can cause testicular evisceration. It requires surgical exploration, which should be systematic.

Surgical and Radiological Assessment of Small Intestinal Neoplasms

Purpose: To highlight the role of multi-detector computed tomography in evaluation of small intestinal neoplastic lesions. Patient and Methods: Thirty patients suspected to have small bowel neaoplasms were examined with 64 MDCT and underwent surgical exploration. Result: Contrast enhanced MDCT enterography easily diagnosed twenty patients with small intestinal neoplasms which were confirmed with surgical exploration and histopathological results. Conclusions: Our study has been proved that MDCT can be used as a front-line imaging modality for detection of small bowel neoplasms, regarding its ability to show intraluminal, mural and extraintestinal lesions with their characteristic density and features to successfully differentiate between the different neoplasms and sometimes stage them. However, operative exploration with curative resection or biopsy is still the confirmatory diagnostic method.

OPERATIONS ON ANEURYSMS OF THE ANTERIOR COMMUNICATING ARTERY NOT VISUALIZED BY CEREBRAL ANGIOGRAPHY──REPORT OF FOUR CASES

Four cases of anterior communicating aneurysms are reported with clinical presentations of recurrent intracranial hemorrhage undisclosed in their cerebral angiography. Operative exploration revealed anterior communicating aneurysms in these patients. It is thought possible that these patients harbored aneurysms which failed to exhibit on angiograms due to temporary thrombosis or development of abnormal cerebral vessels. CT scanning was important for diagnosis of these patients.

Can transcutaneous perianal ultrasonography be the first-line diagnostic instrument for evaluating pediatric perianal fistulas?

Background:Pediatric perianal fistula is a common disorder.It is more difficult to detect the fistula tract and internal opening(IO)in children than in adults.This study aimed to evaluate the clinical diagnostic value of transcutaneous perianal ultrasound for children with perianal fistula.Methods:A retrospective review was conducted by analysing the preoperative transcutaneous perianal ultrasound and intraoperative exploration results of 203 consecutive patients who were<3 years old and diagnosed with perianal fistula.Analyses were conducted to evaluate the accuracy and consistency of utilizing the transcutaneous perianal ultrasound in the diagnosis of the complexity and location of the IO of perianal fistulas.Results:Compared with intraoperative exploration,the preoperative transcutaneous perianal ultrasonography has almost perfect agreement(Kappa=0.881,P<0.001)in the diagnosis of fistula tract complexity and IO with a sensitivity of 92%and a specificity of 97%.In addition,both intraoperative exploration and transcutaneous perianal ultrasound diagnosis showed high consistency in the identification of the IO of perianal fistulas(QuadrantⅠKappa=0.831,QuadrantⅡKappa=0.773,QuadrantⅢKappa=0.735,QuadrantⅣKappa=0.802,all P<0.01).The IOs were mainly distributed in QuadrantsⅣandⅡin both simple and complex fistulas.Conclusions:Transcutaneous perianal ultrasound,as a non-invasive and simple imaging technique,showed high accuracy in the diagnosis and identification of the fistula classification and IO location.It could be considered a first-line diagnostic instrument for evaluating perianal fistulas among children.