Global 30-day morbidity and mortality of surgery for perforated peptic ulcer: GRACE study.

BACKGROUND: There is little international data on morbidity and mortality of surgery for perforated peptic ulcer (PPU). This study aimed to understand the global 30-day morbidity and mortality of patients undergoing surgery for PPU and to identify variables associated with these. METHOD: We performed an international study of adults (≥ 18 years) who underwent surgery for PPU from 1st January 2022 to 30th June 2022. Patients who were treated conservatively or had an underlying gastric cancer were excluded. Patients were divided into subgroups according to age (≤ 50 and > 50 years) and time from onset of symptoms to hospital presentation (≤ 24 and > 24 h). Univariate and Multivariate analyses were carried out to identify factors associated with higher 30-day morbidity and mortality. RESULTS:  1874 patients from 159 centres across 52 countries were included. 78.3% (n = 1467) of the patients were males and the median (IQR) age was 49 years (25). Thirty-day morbidity and mortality were 48.5% (n = 910) and 9.3% (n = 174) respectively. Median (IQR) hospital stay was 7 (5) days. Open surgery was performed in 80% (n = 1505) of the cohort. Age > 50 years [(OR = 1.7, 95% CI 1.4-2), (OR = 4.7, 95% CI 3.1-7.6)], female gender [(OR = 1.8, 95% CI 1.4-2.3), (OR = 1.9, 95% CI 1.3-2.9)], shock on admission [(OR = 2.1, 95% CI 1.7-2.7), (OR = 4.8, 95% CI 3.2-7.1)], and acute kidney injury [(OR = 2.5, 95% CI 1.9-3.2), (OR = 3.9), 95% CI 2.7-5.6)] were associated with both 30-day morbidity and mortality. Delayed presentation was associated with 30-day morbidity [OR = 1.3, 95% CI 1.1-1.6], but not mortality. CONCLUSIONS: This study showed that surgery for PPU was associated with high 30-day morbidity and mortality rate. Age, female gender, and signs of shock at presentation were associated with both 30-day morbidity and mortality.

Thyrolipoma presentation as a huge multinodular goiter; A case report of an extremely rare entity.

IMPORTANCE AND IMPORTANCE: Thyroid lipomatosis is a rare entity of thyroid gland lesions. The exact etiopathogenesis of this condition is unknown. Most patients presented with compression symptoms. Radiological investigations such as neck ultrasonography (U/S) and computed tomography (CT) are crucial to evaluate and diagnose fat-containing thyroid tumors, while the definitive diagnosis is achieved by the histopathological study. CASE PRESENTATION: A 78-year-old female patient, with a background medical history of diabetes mellitus type II and chronic kidney disease, presented to our hospital with a seven-month history of large-sized neck swelling. On physical examination, the neck mass was firm, nodular, hard in consistency, and asymmetrical. The neck swelling was associated with swallowing difficulties and minimal voice changes. Laboratory investigations were unremarkable. Neck U/S showed thyroid goiter. FNA and FNAC were also done. Then, neck CT was performed, and bilateral lobulated fat density was detected. So, a total thyroidectomy was performed, and the resected specimen was sent for histopathology studies. The postoperative period was uneventful. CLINICAL DISCUSSION: Diffuse thyroid lipomatosis is an unusual non-neoplastic lesion. The clinical features of thyro-lipomatosis include compression symptoms. Radiological tools and cytology aid in diagnosis demonstration but the specific diagnosis is achieved by histopathology. CONCLUSION: Due to the rare etiologic origin and unknown pathogenesis of thyrolipoma, we report the case of a 78-year-old female patient with enlarged neck swelling, found to be thyroid lipomatosis.

Using Absorbable Sutures for Traumatic Wound Closure to Avoid Additional Hospital Visits for Suture Removal During the COVID-19 Pandemic: A Randomized Controlled Trial.

Introduction The COVID-19 pandemic worldwide forced governments to undertake intervention measures to encourage social distancing. Meanwhile, traumatic skin lacerations require multiple hospital visits for dressing changing and suture removal since they are usually repaired with non-absorbable sutures. These visits can be avoided by using absorbable sutures instead. However, absorbable sutures carry the "potential" risk of wound infection. In the current study, our first objective was to determine the non-inferiority of absorbable sutures regarding infection rate after repairing traumatic wound lacerations in comparison to the conventional non-absorbable ones. Our second objective was to evaluate the superiority of absorbable sutures in regard to postoperative clinic visits for suture removal and wound dressing compared to the non-absorbable ones. Methods A sample of 471 patients with traumatic skin lacerations was analyzed during the COVID-19 pandemic in April 2020. In the control group, wounds were repaired using non-absorbable sutures, while rapid-onset absorbable sutures were used in the treatment group. By conducting a phone/video call follow-up after 21 days, several parameters regarding infection signs and clinic visits were compared between both groups. Results A significant decrease in total trauma patients (45.4%) and those who required suturing (51.2%) was observed in April 2020 compared to the same month of the previous four years (p = 0.001 (2016), p = 0.027 (2017), p = 0.027 (2018), and p = 0.001 (2019)). Regarding wound infection, no statistically significant difference (p = 0.623) was observed between the absorbable (3.2%) and non-absorbable (4.9%) groups. Using absorbable sutures resulted in significantly (p < 0.001) fewer postoperative hospital visits compared to using non-absorbable sutures (mean: one versus three visits). Conclusion Using absorbable sutures to repair traumatic wound lacerations is safe regarding wound healing and infection rates. They also reduce postoperative hospital visits since they are not intended to be removed. Therefore, they should be considered during a pandemic to reduce hospital visits for suture removal, which will subsequently enhance social distancing and relieve hospital load.

Imaging changes after breast reconstruction with fat grafting - Retrospective study of 90 breast cancer.

OBJECTIVE: To evaluate the breast imaging changes after fat grafting and its impact on cancer follow up. METHODS: This is a retrospective observational study conducted on patients who underwent fat grafting for breast reconstruction. We reviewed mammographic and ultrasound images of patients. Fisher's exact test was used to analyze results. The level of significance was set at P < 0.05. RESULTS: A total of ninety patients with breast cancer had fat grafting. Fifty eight patients for defects following post mastectomy reconstruction and 32 for wide local excision defects. The mean follow up was 37.4 months. Benign lumps were identified in 23/90 cases (25 percent). Mammograms were reported as BI-RADS I in 21/32 cases (72 percent) and BI-RADS II in 8/32 cases (28 percent). BI-RADs III score was reported in two patients on further follow up imaging, both were re-classified as BI-RADS II after biopsy. A total of eight patients (8.9 percent) required biopsy. No local recurrences or new cancers were observed in any patients. CONCLUSION: Our study suggests radiological changes after fat grafting are almost always benign with no adverse outcome on cancer follow up.