Intraoperative motive for incomplete resection in primary retroperitoneal sarcoma.

INTRODUCTION: Surgical resection is the current standard of care for retroperitoneal sarcoma (RPS). Recent data suggests that up to 5% of patient have incomplete (R2) resection. The exact reason why patients scheduled for surgery with a curative intent to treat ended up with an R2 resection is largely unknown. AIM OF THE STUDY: To identify intraoperative findings responsible for incomplete (R2) resection in primary RPS. METHODS: All records of consecutive patients scheduled for a non-metastatic primary RPS surgery between 1995 and 2020 in a tertiary care sarcoma centre were retrospective analyzed. RESULTS: Among the 347 patients scheduled for surgery, 13 (3.7%) had an incomplete (R2) resection. The reasons for incomplete surgery were intraoperative finding of vascular involvement of great vessels in 5 patients, previously undetected peritoneal metastases in 5 patients, invasion of contralateral kidney/ureter in 2 patients and the need to preserve both kidneys in 1 patient because of his past medical history. Among these patients, 3 had a laparotomy without resection and 10 had a partial resection (i.e. debulking surgery). Severe postoperative complications occurred in 5 patients. The median length of stay in hospital was 19days. After a median follow-up of 12months, the median survival of patients after incomplete resection was 18months. The 1-y, 5-y and 8-y overall survival (OS) for these patients were 46%, 14%, and 7%, respectively. CONCLUSION: Incomplete (R2) resection for a primary RPS surgery is rare in specialized sarcoma center. The next steps should be to identify the preoperative criteria that lead to this accurate selection and to define the best practice in front of a peroperative discovery of an unresectable RPS. LEVEL OF EVIDENCE: III.

Evaluation of Annona muricata (Graviola) leaves activity against experimental trichinellosis: in vitro and in vivo studies.

Our work aimed to evaluate the possible effect of Annona muricata (Graviola) leaf extract on Trichinella spiralis in in vitro and in vivo studies. Trichinella spiralis worms were isolated from infected mice and transferred to three culture media - group I (with no drugs), group II (contained Graviola) and group III (contained albendazole) - then they were examined using the electron microscope. In the in vivo study, mice were divided into five groups: GI (infected untreated), GII (prophylactically treated with Graviola for seven days before infection), GIII (infected and treated with Graviola), GIV (infected and treated with albendazole) and GV (infected and treated with a combination of Graviola plus albendazole in half doses). Drug effects were assessed by adults and larvae load beside the histopathological small intestinal and muscular changes. A significant reduction of adult and larval counts occurred in treated groups in comparison to the control group. Histopathologically, marked improvement in the small intestinal and muscular changes was observed in treated groups. Also, massive destruction of the cultured adults' cuticle was detected in both drugs. This study revealed that Graviola leaves have potential activity against trichinellosis, especially in combination with albendazole, and could serve as an adjuvant to anti-trichinellosis drug therapy.

Electron microscope images of human coronaviruses - Reality versus illusion.

Since the outbreak of COVID-19 as a pandemic disease earlier in 2020, several publications reported the electron microscope images of SARS-CoV-2. This article reviews 73 articles from March 1956 till April 2021, focusing on the ultrastructure characteristics of the coronaviruses. We present the scientific debate and provide an opinion on the current controversy of electron microscopic images interpreted as SARS-CoV-2 particles in specimens from patients with COVID-19. Finally, we report our findings in a post-mortem lung specimen of a COVID-19 patient. With this we hope to facilitate accurate interpretation of TEM findings, and contribute to the building of a unified database in the face of COVID-19 (Tab. 2, Fig. 8, Ref. 81). Keywords.

Augmented reality in liver surgery.

INTRODUCTION: During an operation, augmented reality (AR) enables surgeons to enrich their vision of the operating field by means of digital imagery, particularly as regards tumors and anatomical structures. While in some specialties, this type of technology is routinely ustilized, in liver surgery due to the complexity of modeling organ deformities in real time, its applications remain limited. At present, numerous teams are attempting to find a solution applicable to current practice, the objective being to overcome difficulties of intraoperative navigation in an opaque organ. OBJECTIVE: To identify, itemize and analyze series reporting AR techniques tested in liver surgery, the objectives being to establish a state of the art and to provide indications of perspectives for the future. METHODS: In compliance with the PRISMA guidelines and availing ourselves of the PubMed, Embase and Cochrane databases, we identified English-language articles published between January 2020 and January 2022 corresponding to the following keywords: augmented reality, hepatic surgery, liver and hepatectomy. RESULTS: Initially, 102 titles, studies and summaries were preselected. Twenty-eight corresponding to the inclusion criteria were included, reporting on 183patients operated with the help of AR by laparotomy (n=31) or laparoscopy (n=152). Several techniques of acquisition and visualization were reported. Anatomical precision was the main assessment criterion in 19 articles, with values ranging from 3mm to 14mm, followed by time of acquisition and clinical feasibility. CONCLUSION: While several AR technologies are presently being developed, due to insufficient anatomical precision their clinical applications have remained limited. That much said, numerous teams are currently working toward their optimization, and it is highly likely that in the short term, the application of AR in liver surgery will have become more frequent and effective. As for its clinical impact, notably in oncology, it remains to be assessed.

Laparoscopic fellowship training can deliver a competent laparoscopic surgeon and trainer.

AIM: The study investigated whether experience gained during a UK laparoscopic colorectal fellowship enabled the fellow subsequently to train consultant colleagues in laparoscopic surgery. METHOD: In one unit a newly appointed post-laparoscopic fellowship consultant (PFC) mentored his other two colleagues. Prospectively collected data regarding surgical outcome were compared with those of the year preceding the PFC appointment. RESULTS: In the preceding year 18.5% of 260 resections were attempted laparoscopically. This increased to 92.6% (of 270) in the year after (P < 0.0001). Respective conversion rates were 4.2% and 8.4% (P = 0.5524). In the first 6 months after PFC appointment, mentored consultants performed 23 supervised cases. In the second 6 months they carried out 58 procedures independently and trainees performed 38 supervised cases. There was no significant difference in anastomotic leakage and readmission and 30-day mortality rates between the pre- and post-PFC periods. CONCLUSION: A laparoscopic fellowship enables the PFC to mentor consultant colleagues safely and effectively.

Demographic situation and prospects in Africa.

PIP: Summarizes recent trends and projections through the year 2000 of population size, population growth, fertility, mortality, and age structure in Africa. Fertility is very high, mortality is fairly high but gradually declining, the age distribution is heavily weighted toward children, and the population growth rate has been increasing--it is at 2.77% and may rise yet more. All of these characteristics vary from region to region. It is estimated that fertility will not decline much if at all in the next 20 years due to a number of sociological factors, and the population may increase from 132 million in 1980 to 246 million or more in 2000. Several graphs and data tables are appended.^ieng

Rhabdomyolysis and acute renal failure in head injury patients.

Rhabdomyolysis is a known complication of crush injuries, but is not known to complicate the course of the patients with head injuries without other apparent skeletal muscle injuries. The frequency of renal failure may be high in such group of patients. We conducted a prospective study to evaluate such incidence on twenty patients with head injuries. Ten patients (50%) had other injuries in addition, but none of the patients had crush injury. All the patients were investigated daily for serum electrolytes, urea, creatinine, creatinine phosphokinase (CPK) and myoglobulinuria. All these patients were on a dehydrating protocol to prevent brain edema, including administration of dopamine infusion (1-3 microg/kg/min), intravenous bolus doses of mannitol, and sodium bicarbonate. Nine patients (45%) developed renal impairment, three of them had no other apparent skeletal muscle injuries, but none of them required dialysis. Rhabdomyolysis is not uncommon in head injury patients in the absence of apparent skeletal muscle injuries, and may precipitate renal failure. This may have therapeutic implications to prevent the incidence of acute renal failure in such group of patients.