Incidental Gastric Signet Ring Cell Carcinoma: A Call for an Aggressive Approach.

BACKGROUND: Signet ring cell carcinoma (SRCC) is classified as an undifferentiated gastric carcinoma with poor prognosis. Early SRCCs are associated with improved prognosis. OBJECTIVES: To describe the outcomes of incidental SRCC. METHODS: In this case series, 900 medical charts of patients with SRCC were screened to identify patients with incidental SRCC, defined as diagnosed in random, non-focal-lesion-targeted biopsies. RESULTS: Six patients were diagnosed with incidental SRCC and underwent gastrectomy. The final pathology of five patients revealed one or more small foci of early SRCC without lymphovascular invasion. Only one patient had no evidence of malignancy. The median follow-up after surgery was 4.2 years (50 months, range 37-90 months). No deaths or recurrences were recorded during the follow-up period. These results resemble the reported survival rate for early SRCC. CONCLUSIONS: An aggressive surgical approach in incidental gastric SRCC patients is recommended, as they have a chance for long-term survival.

Correlations between Disease Severity and Rehabilitation Outcomes in Patients Recovering from Covid-19 Infection.

OBJECTIVE: Based on long-term follow-up of patients with COVID-19, to evaluate whether the severity of acute COVID-19 infection affects rehabilitation outcomes. DESIGN: Observational cohort study. SUBJECTS: A total of 61 post-acute COVID-19 patients underwent inpatient and outpatient customized rehabilitation treatment. METHODS: The severity of acute COVID-19 infection was measured with the World Health Organization Clinical Progression Scale (WHO-CPS). Motor, cognitive, and functional variables were measured using standard and specified scales 6 months or more after acute illness. RESULTS: Of the 61 subjects, 65.6% had severe disease according to WHO-CPS. Significant improvement was found in activities of daily living functions (Functional Independence Measure (FIM) at admission 103.7 ± 18.9 vs FIM at discharge 118.7 ± 6.8) (p < 0.00). Of participants, 88% were able to wean off oxygen completely. A significant correlation was found between higher WHO-CPS, prolonged acute hospitalization, and days of ventilation were correlated with lower total and motor FIM at admission, but not with cognitive FIM or Montreal Cognitive Assessment (MoCA). No correlation was found between WHO-CPS, prolonged acute hospitalization and day of ventilation and funnctional level at discharge. CONCLUSION: The severity of acute COVID-19 infection affects the functional status of survivors at admission to rehabilitation, but, contrary to expectations, not the functional outcomes at discharge. These findings show that even patients with severe acute COVID-19 infection may improve their daily functioning significantly during rehabilitation program.

Correlations between Electro-Diagnostic Findings, the Severity of Initial Infection, and the Rehabilitation Outcomes among COVID-19 Patients.

Patients with Coronavirus-2019 (COVID-19) manifest many neuromuscular complications. We evaluated the correlations between electromyography and nerve conduction measurements among COVID-19 patients and the severity of the initial infection, as well as the rehabilitation outcomes, and searched for the factors which best predict the rehabilitation outcomes. A total of 19 COVID-19 patients (16 men; mean ± SD age 59.1 ± 10.4), with WHO clinical progression scale of 6.8 ± 2.3, received rehabilitation for 3.9 ± 2.5 months. The Functional Independence Measure (FIM), the 10 m walk test, the 6 minute walk test, and grip force were collected before and after the rehabilitation period. Motor Nerve Conduction (MNC), Sensory Nerve Conduction (SNC) and electromyographic abnormalities were measured. All of the MNC measures of the median nerve correlated with the WHO clinical progression scale and duration of acute hospitalization. The MNC and SNC measures correlated with the rehabilitation duration and with FIM at discharge. The MNC distal latency of the median and the peroneal nerves and the MNC velocity of the median and tibial nerves predicted 91.6% of the variance of the motor FIM at discharge. We conclude that nerve conduction measurements, especially in COVID-19 patients with severe illness, are important in order to predict prognosis and rehabilitation outcomes.

Long-term Outcomes of Endoscopic Thoracoscopic Sympathectomy for Primary Focal Palmar Hyperhidrosis: High Patient Satisfaction Rates Despite Significant Compensatory Hyperhidrosis.

BACKGROUND: Endoscopic thoracoscopic sympathectomy (ETS) is the gold standard therapy for primary focal palmar hyperhidrosis (PFPH), resulting in high patient satisfaction rates. The most common side effect of ETS is compensatory hyperhidrosis (CH). Previous studies followed patients' satisfaction degree of surgery and the incidence of CH during a limited follow-up period of 1 to 3 years. The purpose of this study was to investigate the long-term outcomes and patient satisfaction after ETS. MATERIALS AND METHODS: After approval of our institutional review board, we conducted a retrospective review of all consecutive patients who underwent ETS for PFPH at our institution between 1998 and 2019. Electronic medical records were reviewed for short-term outcomes. Long-term outcomes were collected through telephone questionnaires. Primary outcome was the resolution of PFPH. Secondary outcomes were CH and long-term patient satisfaction. RESULTS: During the study period, 256 patients underwent ETS to treat primary focal palmar hyperhidrosis at our institution between the years 1998-2019. One-hundred and fifty (58.6%) patients agreed to participate in the study and were included in the final analysis. The mean age was 23.8 (17 to 58) years, 56% were females. The mean follow-up time was 11±6.1 (1 to 22) years. Ninety-four percent reported resolution of PFPH; however, CH was reported by 90% of participants. CH decreased mean patient satisfaction score from 4.8±0.5 to 3.8±2 ( P =0.009). This effect was more pronounced in patients with CH of the head and neck ( P =0.009). Patients' satisfaction decreased over time from a mean of 4.8±0.4 in the first year after surgery to a mean of 3.7±1.4 12 years or more after surgery ( P <0.001). Despite this, 79% of patients reported they would recommend ETS to other patients. CONCLUSIONS: ETS for PFPH is highly effective and results in high patient satisfaction rates even after long-term follow-up. Despite high rates of postoperative CH, nearly 80% of patients would still recommend the procedure to fellow patients, justifying its reputation as the gold standard treatment for PFPH.

Falls in Post-Polio Patients: Prevalence and Risk Factors.

Individuals with post-polio syndrome (PPS) suffer from falls and secondary damage. AIM: To (i) analyze the correlation between spatio-temporal gait data and fall measures (fear and frequency of falls) and to (ii) test whether the gait parameters are predictors of fall measures in PPS patients. METHODS: Spatio-temporal gait data of 50 individuals with PPS (25 males; age 65.9 ± 8.0) were acquired during gait and while performing the Timed Up-and-Go test. Subjects filled the Activities-specific Balance Confidence Scale (ABC Scale) and reported number of falls during the past year. RESULTS: ABC scores and number of falls correlated with the Timed Up-and-Go, and gait cadence and velocity. The number of falls also correlated with the swing duration symmetry index and the step length variability. Four gait variability parameters explained 33.2% of the variance of the report of falls (p = 0.006). The gait velocity was the best predictor of the ABC score and explained 24.8% of its variance (p = 0.001). CONCLUSION: Gait variability, easily measured by wearables or pressure-sensing mats, is an important predictor of falls in PPS population. Therefore, gait variability might be an efficient tool before devising a patient-specific fall prevention program for the PPS patient.