Diagnostic and Therapeutic Values of Angiogenic Factors in Endometrial Cancer

Endometrial cancer (EC) is the most frequent gynecological malignancy in developed countries and requires a relatively invasive diagnostic evaluation and operative therapy as the primary therapeutic approach. Angiogenesis is one of the main processes needed for cancer growth and spread. The production of angiogenic factors (AFs) appears early in the process of carcinogenesis. The detection of AFs in plasma and tissue and a better understanding of the angiogenic properties of EC may contribute not only to earlier but also more specific diagnosis and consequently tailored and individual therapeutic approaches. AFs and their receptors also have high potential as binding sites for targeted cancer therapy. In this review, we discuss angiogenesis in EC and the characteristics of the AFs that most contribute to angiogenesis in EC. We also highlight therapeutic strategies that target angiogenesis as potential EC therapy.

Extrusion of the distal ventriculoperitoneal shunt catheter through the umbilicus: a systematic literature review from 1973 to 2021

Trans-umbilical extrusion of the distal ventriculoperitoneal shunt catheter is a rare complication of the VPS insertion. The objectives of this review were to analyze various variables like the age, sex, indication for VPS insertion, clinical presentation, the operative therapy offered for the management, and outcome of the cases published/managed for the trans-umbilical extrusion of the distal VPS shunt catheter. In 1973, the maiden case of trans-umbilical extrusion of the distal VPS catheter was published. Literature/case reports were retrieved from 1973 to October 31, 2021. A total of n=24 (12 males, 12 females) cases were recruited for this systematic review. All of them were children below the age of 13-years. In four-fifths (n=19) of children, the initial VPS catheter was inserted during the first 6-months of life. The median age of children at the time of diagnosis of the above-described VPS complication was 7.5 (42.21 SD) months, and it ranged from 2 months to 13 years of age. The median interval from the initial VPS insertion/last VPS revision to the diagnosis of complication was 4 (24.77 SD) months, and it ranged from 3 weeks to 8 years. The main complaint was the extrusion of the distal VPS catheter through the umbilicus. Surgical procedures performed for the management were (a) removal of the entire VPS catheter n=15, (b) removal of distal/part of distal VPS catheter n=5, and (C) others n=2. For VPS catheter revision; delayed re-VPS insertion was performed in n=10, immediate revision of the distal VPS catheter in n=3, and others. Three (12.5%) children died during the postoperative and follow-up period. The distal VPS catheter extrusion through the umbilicus is a rare complication of VPS insertion, and it occurred exclusively in children. In 70% (n=17) of children, it was documented ≤6 months afterward of the VPS insertion. Delayed re-VPS catheter insertion was preferred for 40% of the children for VPS revision procedures.

Near Disappearance of Splenorrhaphy as an Operative Strategy for Splenic Preservation After Trauma

Background Splenorrhaphy was once used to achieve splenic preservation in up to 40% of splenic injuries. With increasing use of nonoperative management and angioembolization, operative therapy is less common and splenic injuries treated operatively are usually high grade. Patients are often unstable, making splenic salvage unwise. Modern surgeons may no longer possess the knowledge to perform splenorrhaphy. Methods The records of adult trauma patients with splenic injuries from September 2014 to November 2018 at an urban level I trauma center were reviewed retrospectively. Data including American Association for the Surgery of Trauma splenic organ injury scale, type of intervention, splenorrhaphy technique, and need for delayed splenectomy were collected. This contemporary cohort (CC) was compared to a historical cohort (HC) of splenic injuries at a single center from 1980 to 1989 (Ann Surg 1990; 211: 369). Results From 2014 to 2018, 717 adult patients had splenic injuries. Initial management included 157 (21.9%) emergent splenectomy, 158 (22.0%) angiogram ± embolization, 371 (51.7%) observation, and only 10 (1.4%) splenorrhaphy. The HC included a total of 553 splenic injuries, of which 313 (56.6%) underwent splenectomy, while splenorrhaphy was performed in 240 (43.4%). Those who underwent splenorrhaphy in each cohort (CC vs HC) were compared. Conclusion The success rate of splenorrhaphy has not changed. However, splenorrhaphy now involves only electrocautery with topical hemostatic agents and is used primarily in low-grade injuries. Suture repair and partial splenectomy seem to be “lost arts” in modern trauma care.

Laparoscopic Treatment of Early Postoperative Ileus After Laparotomy.

Aim. The case report demonstrates a successful laparoscopic treatment of early postoperative small bowel obstruction after open strangulated umbilical hernia repair with mesh.Case report. An 86-year-old female was admitted to the hospital due to abdominal pain for 2 days localised in the umbilical region. A diagnosis of strangulated umbilical hernia was set, and emergency operative therapy was performed. On the third postoperative day the patient showed symptoms of bowel obstruction, confirmed on CT. An emergency laparoscopy proceeded. It revealed small intestine loop fixation to the mesh through the peritoneal defect. While separating the intestine a defect in bowel wall was found and sutured laparoscopically. Patient was discharged from the hospital on the 8th postoperative day.Conclusion. Laparoscopic treatment after open hernia surgery is an alternative access for redo surgery in early postoperative period. It provides acceptable results even in contaminated area without needs to reopen surgical wound.

Operative Therapy of Parkinson's Disease and the Role of Neurologist

Dopaminergic agents are still the mainstay of therapy in Parkinson's disease. Such dopamine replacement therapy results in a reduction in motor symptoms in the early stages of the disease. However, dopaminergic agents will cause motor (motor fluctuations and dyskinesia) and nonmotor (sensory, autonomic, and psychiatric) complications, 50% will occur after 5 years, The operative approach has been shown to be effective in improving motor symptoms in PD. Deep brain stimulation (DBS), which is the second largest finding after levodopa, is still the first choice of operative treatment for PD, however, other operative therapies such as ablative therapy (radiofrequency, stereotactic radiosurgery, focused ultrasound thermal ablation, laser interstitial thermal therapy) have almost the same effectiveness. with DBS. As primary care physicians, it is very important for neurologists to understand the role in operative therapy that is currently developing. Keywords: Parkinson's disease, surgery, neurologist, therapy.

DIFFERENT SEXUAL FUNCTION OF UTERIC PROLAPSE PATIENTS BETWEEN OPERATIVE AND NON-OPERATIVE

Background: The prevalence of pelvic organ prolapse (POP) increases as the age increment. Uterine prolapse is the most common type of POP cases. Although uterine prolapse is not a life-threatening condition, it can affect a woman's quality of life. Either operative or non-operative therapy can affect reproductive or sexual function. The purpose of this study was to analyze differences in sexual function scores in uterine prolapse patients between operative and non-operative therapy. Methods: This is an analytic observational study with a cross-sectional design. Sampling technique used convenience sampling and data were analyzed by Mann-Withney test using SPSS. Results: There were 30 samples, 14 of them did operative therapy and 16 of them did non-operative or pesarry therapy. Data analysis using Mann-Withney test shown that the operative group had median score of 16,6 while the non-operative group had median score of 19,9 with p=0,124 (p>0,05). Conclusion: There was no significant difference of sexual function scores between patients with operative therapy and non-operative therapy.

A systematic review of the perforated duodenal diverticula: lessons learned from the last decade

Background The perforated duodenal diverticulum remains a rare clinical entity, the optimal management of which has not been well established. Historically, primary surgery has been the preferred treatment modality. This was called into question during the last decade, with the successful application of non-operative therapy in selected patients. The aim of this systematic review is to identify cases of perforated duodenal diverticula published over the past decade and to assess any subsequent evolution in treatment. Methods A systematic review of English and non-English articles reporting on perforated duodenal diverticula using MEDLINE (2008–2020) was performed. Only cases of perforated duodenal diverticula in adults (> 18 years) that reported on diagnosis and treatment were included. Results Some 328 studies were identified, of which 31 articles met the inclusion criteria. These studies included a total of 47 patients with perforated duodenal diverticula. This series suggests a trend towards conservative management with 34% (16/47) of patients managed non-operatively. In 31% (5/16) patients initially managed conservatively, a step-up approach to surgical intervention was required. Conclusion Conservative treatment of perforated duodenal diverticula appears to be an acceptable and safe treatment strategy in stable patients without signs of peritonitis under careful observation. For patients who fail to respond to conservative treatment, a step-up approach to percutaneous drainage or surgery can be applied. If surgery is required, competence in techniques ranging from simple diverticulectomy to Roux-en-Y gastric diversion or even Whipple’s procedure may be required depending on tissue friability and diverticular collar size.

Role of minimal antibiotic therapy and routine long term post-operative therapy in elective surgery: an evaluation

Background: Antibacterial drugs are powerful agents to prevent infections but excess use of antibiotics led to increase of resistance towards the antibiotics used and thus has risen the expense in medical support.Methods: A total of 250 patients were included in the study. The patients were divided randomly into 2 groups, each containing 125 patients. Group I patients received. Three dosage of injectable ceftriaxone 1 gram intravenous peri-operatively, first dose twelve hour before surgery and second dose half hour before surgical incision and third dose twelve hours after surgery. Group II patients were given injectable ceftriaxone 1 gram intravenous peri-operatively, first dose twelve hour before surgery and second dose half hour before surgical incision and then followed by injection (conventional dose) ceftriaxone 1 gram/day I.V twice daily for the first 5-7 days post-operatively. Using Southampton wound grading system. The wound was inspected on the 3rd, 5th and 7th postoperative day days post operatively.Results: In group I, 15 (12%) cases had grade 2 SSI and in group II, 11 (8.8%) cases had grade 2 SSI. There was no statistical significance: p value is 0.83 and c2 0.048.Conclusions: A minimal dose antibiotic prophylaxis is equally efficient and has added advantage of reducing the duration of hospital stay and cost of medicines for the patients. Hence minimal dose antibiotic is better than a routine long term antibiotics therapy.

T2-mapping MRI evaluation of patellofemoral cartilage in patients submitted to intra-articular platelet-rich plasma (PRP) injections

This study evaluated the ability of T2 mapping magnetic resonance imaging at 3 T, in addition to morphological sequences, to assess efficacy of platelet-rich plasma (PRP) injections, characterizing qualitatively and quantitatively the grade of knee cartilage repair in patients with patellofemoral chondropathy. We retrospectively studied 34 patients (22 men, 12 women, mean age 41.8 years, including 22 men) with patellofemoral knee chondropathy, who underwent intra-articular PRP injections and completed a clinical and instrumental follow-up. As control group, we evaluated 34 patients who underwent non-operative therapy. All patients were submitted to clinical (using VAS and WOMAC index) and imaging studies with 3 T magnetic resonance with cartilage analysis with T2 mapping sequences for cartilage analysis before and after treatment. In the study group, mean pre-treatment T2 relaxation time values were 44.2 ± 2.5 ms, considering all articular cartilage compartments, with significant reduction at the follow-up (p < 0.001). At the index compartment, mean pre-treatment T2 relaxation times values were 47.8 ± 3.6 ms, with statistically significant reduction at the follow-up (p < 0.001). Evaluation of focal cartilage lesions reported pre-treatment mean T2 value of 70.1 ± 13.0 ms and post-treatment mean value of 59.9 ± 4.6 ms (p < 0.001). From a clinical point of view, the pre-treatment WOMAC and VAS scores were 18.3 ± 4.5 and 7 (IQR:6–7.2), respectively; the post-treatment values were 7.3 ± 3.2 and 2 (IQR: 1.7–3.0), respectively (p < 0.001). In the control group, despite clinical improvement, we didn’t find significant T2 values change during the follow-up period. In conclusion, T2 mapping is a valuable indicator for chondropathy and treatment-related changes over time.

Appendiceal adenocarcinoma found by surgery for acute appendicitis is associated with older age

Background Appendectomy for acute appendicitis is the most common procedure performed emergently by general surgeons in the United States. The current management of acute appendicitis is increasingly controversial as non-operative management gains favor. Although rare, appendiceal neoplasms are often found as an incidental finding in the setting of appendectomy. Criteria and screening for appendiceal neoplasms are not standardized among surgical societies. Methods The National Surgical Quality Improvement Program (NSQIP) database was queried for all patients who underwent appendectomy over a 9-year period (2010–2018). Over the same time period, patients who underwent appendectomy in two municipal hospitals in The Bronx, New York City, USA were reviewed. Results We found a 1.7% incidence of appendiceal neoplasms locally and a 0.53% incidence of appendiceal tumors in a national population sample. Both groups demonstrated an increased incidence of appendiceal carcinoma by age. This finding was most pronounced after the age of 40 in both local and national populations. In our study, the incidence of appendiceal tumors increased with each decade interval up to the age of 80 and peaked at 2.1% in patients between 70 and 79 years. Conclusions Appendiceal adenocarcinomas were identified in patients with acute appendicitis that seem to be associated with increasing age. The presence of an appendiceal malignancy should be considered in the management of older patients with acute appendicitis before a decision to embark on non-operative therapy.