Elective laparoscopic cholecystectomy: recurrent biliary admissions predispose to difficult cholecystectomy

Introduction Patients undergoing elective laparoscopic cholecystectomy (ELLC) represent a heterogeneous group making it challenging to stratify risk. The aim of this paper is to identify pre-operative factors associated with adverse peri- and post-operative outcomes in patients undergoing ELLC. This knowledge will help stratify risk, guide surgical decision making and better inform the consent process. Methods All patients who underwent ELLC between January 2015 and December 2019 were included in the study. Pre-operative data and both peri- and post-operative outcomes were collected retrospectively from multiple databases using a deterministic records-linkage methodology. Patients were divided into groups based on clinical indication (i.e. biliary colic versus cholecystitis) and adverse outcomes were compared. Multivariate regression models were generated for each adverse outcome using pre-operative independent variables. Results Two-thousand one hundred and sixty-six ELLC were identified. Rates of peri- and post-operative adverse outcomes were significantly higher in the cholecystitis versus biliary colic group and increased with number of admissions of cholecystitis (p < 0.05). Rates of subtotal (29.5%), intra-operative complication (9.8%), post-operative complications (19.6%), prolonged post-operative stay (45.9%) and re-admission (16.4%) were significant in the group of patients with ≥ 2 admissions with cholecystitis. Conclusion Our data demonstrate that patients with repeated biliary admission (particularly cholecystitis) ultimately face an increased risk of a difficult ELLC with associated complications, prolonged post-operative stay and readmissions. These data provide robust evidence that individualised risk assessment and consent are necessary before ELLC. Strategies to minimise recurrent biliary admissions prior to LC should be implemented.

Benefits and limitations for the use of radiation dose management systems in medical imaging. practical experience in a university hospital

Objectives: Radiation dose management systems (DMS) are currently to help improve radiation protection in medical imaging and interventions. This study presents our experience using a homemade DMS called DOLQA (Dose On-Line for Quality Assurance). Methods: Our DMS is connected to 14 X-ray systems in a university hospital linked to the central data repository of a large network of 16 public hospitals in the Autonomous Community of Madrid, with 6.7 million inhabitants. The system allows us to manage individual patient dose data and groups of procedures with the same clinical indications, and compare them with diagnostic reference levels (DRLs). The system can also help to prioritize optimisation actions. Results: This study includes results of imaging examinations from 2020, with 3,7601 procedures and 28,6471 radiation events included in the radiation dose structured reports (RDSR), for computed tomography (CT), interventional procedures, positron emission tomography-CT (PET-CT) and mammography. Conclusions: The benefits of the system include: automatic registration and management of patient doses, creation of dose reports for patients, information on recurrent examinations, high dose alerts, and help to define optimisation actions. The system requires the support of medical physicists and implication of radiologists and radiographers. DMSs must undergo periodic quality controls and audit reports must be drawn up and submitted to the hospital’s quality committee. The drawbacks of DMSs include the need for continuous external support (medical physics experts, radiologists, radiographers, technical services of imaging equipment and hospital informatics services) and the need to include data on clinical indication for the imaging procedures. Advances in knowledge: DMS perform automatic management of radiation doses, produces patient dose reports, and registers high dose alerts to suggest optimisation actions. Benefits and limitations are derived from the practical experience in a large university hospital.

The Role of a Virtual Noncalcium Dual-Energy CT Application in the Detection of Bone Marrow Edema in Peripheral Osteomyelitis

Purpose: To determine the sensitivity and specificity of dual-energy CT (DECT) virtual noncalcium images (VNCa) with bone and soft tissue reconstructions in the diagnosis of osteomyelitis. Materials & Methods: Between December 1, 2014 to December 1, 2020, 91 patients who had 99 DECT performed for a clinical indication of osteomyelitis with corresponding MRI, triphasic bone scan and/or white blood cell scintigraphy with CT/SPECT performed either 2 weeks before or 1 month after the DECT were retrospectively identified. The presence or absence of osteomyelitis was established using a second imaging test, bone biopsy or surgery. Two radiologists interpreted VNCa images alone and with bone and soft tissue reconstructions for osteomyelitis. Fleiss k statistics was used to assess inter-level agreement. Results: Osteomyelitis was present in 26 cases (26.2%), of which 4 cases (4%) had co-existing septic arthritis. DECT was performed at the following sites: ankle/foot (n = 59), calf (n = 12), knee (n = 3), thigh (n = 7), hip (n = 9), pelvis (n = 6), wrist/hand (n = 1), and shoulder (n = 2). Sensitivity with VNCa images alone was 53.8% and 73.1% and specificity was 84.9% and 71.2%. Sensitivity with VNCa images and bone and soft tissue reconstructions was 80.8% and 80.8% and specificity was 80.8% and 72.6%. Interobserver agreement was 76.7% (76 of 99 cases), for VNCa images alone (k = .487), and 66.7% (66 of 99 patients) for bone and soft tissue reconstructions with VNCa images together (k = .390). Conclusion: When VNCa images were combined with bone and soft tissue reconstructions, there is improved sensitivity in the diagnosis of osteomyelitis.

Functional connectivity in Parkinson’s disease candidates for deep brain stimulation

This study aimed to identify functional neuroimaging patterns anticipating the clinical indication for deep brain stimulation (DBS) in patients with Parkinson’s disease (PD). A cohort of prospectively recruited patients with PD underwent neurological evaluations and resting-state functional MRI (RS-fMRI) at baseline and annually for 4 years. Patients were divided into two groups: 19 patients eligible for DBS over the follow-up and 41 patients who did not meet the criteria to undergo DBS. Patients selected as candidates for DBS did not undergo surgery at this stage. Sixty age- and sex-matched healthy controls performed baseline evaluations. Graph analysis and connectomics assessed global and local topological network properties and regional functional connectivity at baseline and at each time point. At baseline, network analysis showed a higher mean nodal strength, local efficiency, and clustering coefficient of the occipital areas in candidates for DBS over time relative to controls and patients not eligible for DBS. The occipital hyperconnectivity pattern was confirmed by regional analysis. At baseline, a decreased functional connectivity between basal ganglia and sensorimotor/frontal networks was found in candidates for DBS compared to patients not eligible for surgery. In the longitudinal analysis, patient candidate for DBS showed a progressively decreased topological brain organization and functional connectivity, mainly in the posterior brain networks, and a progressively increased connectivity of basal ganglia network compared to non-candidates for DBS. RS-fMRI may support the clinical indication to DBS and could be useful in predicting which patients would be eligible for DBS in the earlier stages of PD.

Routine and Innovation in Surgical Therapy of Gallstones

This chapter discusses the anatomy of the gallbladder with the anatomical variations potentially impacting surgical therapy. It is dissertated upon the clinical indication for the surgical therapy with consecutive treatment. The discussion on the surgery focuses on the patient’s safety and strategies for safe cholecystectomy with an optimal approach. Even though the efforts to minimise potential complications are made, the complication may arise, and therefore, the last part of this chapter discusses such cases with optimal clinical management.

HIV Myelopathy- A cross-sectional study of constellation of bone marrow findings in HIV/AIDS

Introduction and Aim: Haematological manifestations in HIV disease is common and can happen at any phase during the disease course. Anemia and thrombocytopenia are the most frequent hematologic abnormalities and are associated with high morbidity and mortality. The objective of current study was to observe and analyse various spectrum of bone marrow changes and haematological abnormalities in HIV/AIDS and to correlate findings with CD4 count. Material and Methods: A total of 44 patients over a period of 5 years were included. Clinical findings, hematological profile, bone-marrow aspirate, biopsy findings and CD4 count of these patients were documented. The association between absolute lymphocyte count (ALC) and CD4 count were further established. Results: The most common clinical indication for bone-marrow aspiration and trephine biopsy was pancytopenia (47.3%), pyrexia of unknown origin (15.1%), and unresolving hepatosplenomegaly (13.6%). Anemia (72.7%) was commonest haematological abnormality. Bone marrow aspirate was normocellular in majority of patients. Marrow findings were correlated with CD4 count and were found to be statistically significant. Tri-lineage dysplasia was observed in 9.1% of patients, and megakaryocytic dysplasia being the commonest(61.4%). Histiocytic aggregates (27.3%) were noted among which 6.8% showed acid fast bacilli in Ziehl-Neelsen stain. Fungal stains revealed histoplasmosis in 4.5% patients. Conclusion: There was a strong negative association between presence of anemia and dysplasia and CD4 count. When CD4 was <200/µL and ALC<1000/mm3, presence of anemia and dysplasia affecting various cell lines were commonly observed; therefore, can be used as indicators to assess the severity of the disease.

Anesthetic management of emergency and planned endovideoscopic gynecological operations in the context of the COVID-19 novel coronavirus infection pandemic (review of the problem)

Purpose of the study. Extract original operational data containing information on the effect of non-steroidal anti-inflammatory drugs (NSAIDs) and the inclusion in the outcomes of the new coronavirus infection SARS-CoV‑19, descriptive analyzes and meta-analyzes, as in emergency and planned in gynecology, NSAIDs are used for the purpose of pain relief.Materials and methods. A systematic literature search was carried out to identify suitable studies in the electronic databases MEDLLINE, the Cochrane Central Register of Controlled Trials, the Chinese Biomedical Literature Database (CBM), domestic publications of the Russian information and analytical portal eLibrary.ru. The time horizon of publications on the problems of pain relief in women during endovideoscopic operations was 20 years. The search for publications in all languages on the use of NSAIDs in the conditions of SARS-CoV‑19 in all patient populations, regardless of gender, age, severity of the condition, was carried out for 2019–2021. The last search query is of 12/20/2021.Results and conclusions. The solution to a number of problems of anesthesia can be the refusal to use narcotic analgesics for endovideoscopic operations for female infertility. There is no clear clinical indication of the effect of NSAIDs on the risk of infection or an increase in the severity of SARS-CoV‑19 disease.

How safe is soy in infancy? Case report of thelarche in an infant

Soy protein based formulas are commonly used in infant nutrition for various indications like lactose intolerance and cow’s milk protein allergy. There are concerns regarding phytoestrogen related and other side effects of these formulas. We are describing a case of possible soy formula induced thelarche in a 7 months infant. There was normalization of estradiol levels with some clinical improvement after stopping soy formula over a follow-up of 12 months duration. We suggest further studies to evaluate hormone levels in infants on soy formulas and to consider it only for appropriate clinical indication and age group.

An ethical review on the search for performance: evidence-based nutrology and the use without indication of anabolic steroids

This study aimed to evaluate what is new in the controversial use of testosterone, as an indication in pathologies such as hypogonadism or its use by athletes and bodybuilders in search of performance. Much is said about the subject and many myths were created without any scientific foundation, one of the objectives of the monograph is to show that when there is a precise clinical indication, testosterone is necessary and extremely beneficial to the patient. It was evaluated in current literature through books and articles, advances in physiology, regulation, treatment of late adult hypogonadism, incidence of use and the most common analogues used by athletes, the harms and benefits expected from the use of the hormone and especially what we have again on cardiovascular safety in testosterone use. After an extensive review, it is still not possible to affirm all the benefits and harms of using the hormone, many old studies are disputed in new studies and even presented results opposite to what was previously believed.